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Outcomes of Prophylactic Enoxaparin against Venous Thromboembolism in Hospitalized Children

E. Bennett1, C. Delgado Corcoran2, C. Heyrend2, R. Wilcox2, C. Pannucci3, V. Faustino4

1University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, United States, 2University of Utah/Primary Children's Hospital, Salt Lake City, United States, 3Plastic Surgery Northwest, Spokane, United States, 4Yale School of Medicine/Yale New Haven Children's Hospital, New Haven, United States

Abstract Number: PB0788

Meeting: ISTH 2021 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

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.
Figure 1. 
Distribution of Anti-Xa Levels after the Initial Enoxaparin Dose (A) and the Number of Measurements Prior to Achievement of Goal Range (B) among Hospitalized Children who received Prophylactic EnoxaparinTable 2. 

 
Variable
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
Obesity 0.91 0.19, 4.38    
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    
Cancer 3.06 0.75, 12.47    
Surgery 1.3 0.38, 4.4    
Trauma 0.4 0.08, 1.92    
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    
Hemoglobin 1.13 0.89, 1.44    
Platelet 1 0.99, 1    
Anti-Xa Measured 0.54 0.16, 1.84    

Factors Associated with Healthcare-Acquired Venous Thromboembolism (VTE) among Hospitalized Children who received Prophylactic Enoxaparin 

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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