Abstract Number: PB0788
Meeting: ISTH 2021 Congress
Background: Hospitalized children are at increased risk of healthcare acquired venous thromboembolism (HA-VTE). Studies have shown that prophylactic enoxaparin may prevent HA-VTE in hospitalized older children, but not in hospitalized infants <1 year old. Other factors may be associated with HA-VTE despite prophylactic enoxaparin.
Aims: To characterize the biochemical and clinical outcomes of hospitalized children who received prophylactic enoxaparin.
Methods: We conducted a single-center, retrospective study of hospitalized children <18 years old who received prophylactic enoxaparin against HA-VTE. Children received age-based enoxaparin dose, which was adjusted to achieve anti-Xa level of 0.2-0.5 IU/mL. Primary biochemical and clinical outcomes were achievement of goal anti-Xa range and development of HA-VTE, respectively. Secondary clinical outcome was development of clinically relevant bleed.
Results: We analyzed 194 children composed of 13 (7%) infants and 181 (93%) older children. Anti-Xa levels were drawn in 9 (69.2%) infants and 107 (59.1%) older children (p=0.47). Goal anti-Xa range was achieved in 6 (66.7%) infants and 88 (82.2%) older children (p=0.37). Median number of anti-Xa levels prior to goal was 2 (interquartile range, IQR: 2, 3) in infants and 1 (IQR: 1, 2) in older children (p=0.01). HA-VTE developed in 2 (15.4%) infants and 9 (5.0%) older children (p=0.16). Personal history of VTE was associated with HA-VTE (odds ratio, OR: 11.98; 95% confidence interval, CI: 2.30, 62.32). Infant status (OR: 6.25; 95% CI: 0.99, 39.53) and prophylactic enoxaparin started within 3 days after hospital admission (OR: 0.25; 95% CI: 0.06, 1.07) were marginally associated with HA-VTE. Bleeds developed in none (0%) of the infants and in 4 (2.2%) older children.
|Unadjusted Odds Ratio||95% Confidence Interval||Adjusted Odds Ratio||95% Confidence Interval|
|Infant||3.47||0.67, 18.07||6.25||0.99, 39.53|
|Personal history of VTE||7.25||1.64, 32.06||11.98||2.30, 62.32|
|Congenital Heart Disease||2.49||0.49, 12.58|
|Admission to the Intensive Care Unit||3.5||0.73, 16.63|
|Sequential compression device||1.26||0.37, 4.27|
|Central venous catheter||5.92||1.25, 28.19|
|Patient on other anticoagulant||1.47||0.30, 7.23|
|Early prophylaxis||0.27||0.07, 1.04||0.25||0.06, 1.07|
|Starting dose||9.37||0.92, 95.27|
|Anti-Xa Measured||0.54||0.16, 1.84|
Conclusions: HA-VTE developed in hospitalized children despite prophylactic enoxaparin. HA-VTE among infants seemed related to delay in achieving goal anti-Xa range. Early administration of therapeutic enoxaparin may prevent HA-VTE in infants and in those with personal history of VTE.
To cite this abstract in AMA style:Bennett E, Delgado Corcoran C, Heyrend C, Wilcox R, Pannucci C, Faustino V. Outcomes of Prophylactic Enoxaparin against Venous Thromboembolism in Hospitalized Children [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/outcomes-of-prophylactic-enoxaparin-against-venous-thromboembolism-in-hospitalized-children/. Accessed September 29, 2023.
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