Original ArticlesThe use of low molecular weight heparin in pediatric patients: A prospective cohort study☆,☆☆
Section snippets
Patient Population
Children admitted to the Hospital for Sick Children, Toronto, Canada, between March 1994 and July 1997 were treated with the LMWH enoxaparin (Rhone Poulenc Rorer, Canada) if the treating physician estimated that the risk/benefit ratio of traditional therapy (UFH/oral anticoagulants) was potentially compromised (high risk of bleeding, required diet or medication alterations, no venous access). For therapy of an established thrombosis or high-risk prophylaxis (cardiomyopathy, prosthetic mitral
Patient Population
There were 189 courses of enoxaparin dispensed during the period from March 1994 to July 1997. Complete data were available in a total of 177 courses of treatment administered in 173 patients, and these patients are the basis of this report. Of the 177 courses of enoxaparin administered, 146 were for management of TEs, and 31 were for prophylaxis. The 12 courses with incomplete data were cases where patients were transferred from HSC to other institutions and follow-up data could not be
DISCUSSION
The current standard of care for children with DVT/pulmonary embolism, UFH followed by oral anticoagulants for at least 3 months, is problematic.11, 12, 13 The advantages of LMWHs in adults7, 8, 10, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 have resulted in increased off-label use of LMWHs in pediatric patients. Few studies describe the pharmacokinetics or use of LMWH in children,6, 13, 25 yet no studies with sufficient sample size estimate the safety and efficacy of LMWHs in managing DVT/PE
Acknowledgements
We would like to thank Lu Ann Brooker for editing this manuscript.
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2019, BJA EducationCitation Excerpt :An increase in bleeding is always a concern. In a prospective cohort study of 146 paediatric patients receiving therapeutic LMWH and 31 patients receiving prophylactic LMWH, there were no major bleeds, and only two minor bleeds at the site of the subcutaneous catheter.18 Heparin-induced thrombocytopenia (HIT) is also a recognised complication of heparin exposure.
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Dr Maureen Andrew is a Career Investigator of the Heart and Stroke Foundation of Canada. Dr Gabrielle deVeber is a fellow of the Heart and Stroke Foundation of Canada. Dr Anthony Chan is a scholar of the Heart and Stroke Foundation of Canada. Dr Patricia Massicotte is a scholar of the Medical Research Council of Canada.
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Reprint requests: M. Patricia Massicotte, MSc, MD, Director of Clinical Haemostasis and Thrombosis Program, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.