981

Abstract

Introduction: Titration and administration of subcutaneous (SC) enoxaparin (Ep) is often difficult in certain distinct populations, such as premature infants and critically ill children with severe edema. Difficulty achieving adequate anticoagulation in this population has led to increased use of intravenous (IV) Ep. Sparse pharmacodynamic data are available for determining the appropriate dose, infusion, duration, and monitoring (by anti-Factor Xa levels) of IV Ep. Hypothesis: The objective of this study is to report our experience with the use of intravenous Ep in neonatal and pediatric patients in the intensive care unit. Methods: We performed a retrospective chart review from 1/1/09-6/30/12 of patients who received IV Ep and had?1 anti-10a level reported. Ep doses were infused over 30 minutes and anti-10a levels were drawn 4 hours after the start of the infusion. Results: 15 patients were included. 14 of 15 patients received IV Ep for treatment and 1 for prophylaxis. Patient ages ranged from 21d -16yrs with a median weight of 5 kg. The median duration of IV therapy was 11 days (range 1-120). The mean initial IV dose was 1.14 ± 0.38 mg/kg/dose q12h and the mean therapeutic IV dose was 1.31 ± 0.52 mg/kg/dose q12h. There were no adverse events reported related to bleeding, thrombosis, or hypersensitivity in the patients evaluated. Conclusions: The pharmacodynamics of a 30 minute IV Ep infusion was found to produce therapeutic 4 hour anti-10a levels similar to SC doses. Although this was a small study, there were no adverse events, suggesting the safety profile may be similar to SC dosing with less pain. These findings suggest that IV Ep may be a viable option for anticoagulating critically ill children and its use warrants further study.