Fast Facts

• Low molecular weight heparin (LMWH) is the anticoagulant of choice for most pediatric patients

• Advantages include:

  • Minimal monitoring requirements

  • Reduced interference of other drugs and diet

  • Reduced heparin induced thrombocytopenia (HIT) risk vs. standard heparin

  • Reduced risk of osteoporosis with long term use vs. standard heparin

• Predictability of the anticoagulant effect is less than in adults, presumably due to altered plasma binding

• Available products at Children's Mercy:

  • Enoxaparin (Lovenox^®)

  • Dalteparin (Fragmin^®) with hematology consult

• Enoxaparin half-life is 6 hours

• Enoxaparin has 110 anti-factor Xa units / mg

• LMWH usually does not prolong the PTT

• LMWH levels are followed using a LMW heparin level based on an anti-factor Xa methodology; LMW heparin levels should be ordered to monitor the effects of LMWH

• LMWH is also referred to as fractionated heparin in many references

• Do not confuse the LMW heparin level with that for standard heparin

• Antithrombin III (AT III) is a cofactor for activity of LMWH and therefore inadequate serum AT III might be a cause for poor response to LMWH

References

David, M., et al. (2007, Jan). Heparin and LMWH in Children. Thrombosis Interest Group of Canada. Retrieved Nov 15, 2018, from http://www.tigc.org/eguidelines/heparinchild07.htm.

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Enoxaparin. Retrieved Nov 2018, from https:online.lexi.com.

Monagle, P., Chan, A. K. C., Goldenberg, N. A., Ichord, R. N., Journeycake, J. M., Nowak-Göttl, U., & Vesely, S. K. (2012). Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e737S-e801S. https://doi.org/10.1378/chest.11-2308



Monagle, P., Cuello, C. A., Augustine, C., Bonduel, M., Brandão, L. R., Capman, T., Chan, A. K. C., Hanson, S., Male, C., Meerpohl, J., Newall, F., O'Brien, S. H., Raffini, L., van Ommen, H., Wiernikowski, J., Williams, S., Bhatt, M., Riva, J. J., Roldan, Y., . . . Vesely, S. K. (2018). American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2(22), 3292-3316. https://doi.org/10.1182/bloodadvances.2018024786

Roach, E. S., Golomb, M. R., Adams, R., Biller, J., Daniels, S., Deveber, G., Ferriero, D., Jones, B. V., Kirkham, F. J., Scott, R. M., & Smith, E. R. (2008). Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke, 39(9), 2644-2691. https://doi.org/10.1161/strokeaha.108.189696