Original Articles
The use of low molecular weight heparin in pediatric patients: A prospective cohort study,☆☆

https://doi.org/10.1016/S0022-3476(00)90005-2Get rights and content

Abstract

Objective: Low molecular weight heparins (LMWHs) offer several advantages over standard anticoagulant therapy (unfractionated heparin/warfarin) including predictable pharmacokinetics, minimal monitoring, and subcutaneous administration. Our objective was to determine the safety and efficacy of LMWHs in children. Methods: A prospective cohort of children treated with the LMWH enoxaparin (Rhone Poulenc Rorer) was monitored at the Hospital for Sick Children, Toronto, Canada, from March 1994 until July 1997. Results: There were 146 courses of LMWH administered for treatment and 31 courses for prophylaxis of thromboembolic events (TEs). Clinical resolution of TEs occurred in 94% of children receiving therapeutic doses of LMWH, and 96% of children receiving prophylactic doses of LMWH had no symptoms of recurrent or new TEs. Major bleeding occurred in 5% of children receiving therapeutic doses. Recurrent or new TEs occurred in 1% and 3% of children receiving therapeutic and prophylactic doses of LMWH, respectively. Conclusion: LMWH appears to be efficacious and safe for both management and prophylaxis of TEs. The results of this cohort study justify a randomized controlled trial comparing LMWH with standard therapy for the management of TEs in children.(J Pediatr 2000;136:439-45)

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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    • Venous thromboembolism in paediatrics

      2019, BJA Education
      Citation 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.

    ☆☆

    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.

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