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Retrospective evaluation of antithrombin III supplementation in neonates and infants receiving enoxaparin for treatment of thrombosis
Author(s) -
Corder Amy,
Held Kristin,
Oschman Alexandra
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24899
Subject(s) - medicine , antithrombin , therapeutic effect , thrombosis , retrospective cohort study , logistic regression , therapeutic index , heparin , anesthesia , drug , pharmacology
Background Thromboembolic events are occurring at increasing rates in neonates and infants. At Children's Mercy Hospitals and Clinics, antithrombin III (AT3) concentrates are often used in combination with enoxaparin to supplement physiologically low AT3 levels. Theoretically, AT3 enhances the anticoagulant activity of enoxaparin and results in decreased time to therapeutic anti‐Xa levels. No data exist on use of AT3 for this indication. Procedure This retrospective study compared time to therapeutic anti‐Xa levels in patients <1 year of age receiving enoxaparin with AT3 (Group 1) and without AT3 (Group 2) for treatment of thrombosis. Primary objective was to compare time to therapeutic anti‐Xa levels (0.5–1 U/ml) between groups. Secondary objectives included comparison of the initial and therapeutic dose of enoxaparin, enoxaparin dose changes, AT3 supplementation, and level monitoring. Bleeding events and cost were also evaluated. Statistical tests included Schuirmann's two one‐sided tests for equivalence and general linear models/logistic regression for independent effects of age, critical illness, and timing of AT3. Results Mean time to therapeutic anti‐Xa levels were not equivalent between Groups 1 and 2 (80.7 vs. 65.2 hours; P = 0.28). Initial enoxaparin dose and number of dose changes were equivalent. Group 1 required higher doses of enoxaparin to achieve therapeutic anti‐Xa levels. Age, critical illness, and timing of AT3 had no effect on time to therapeutic anti‐Xa levels. Bleeding events were not equivalent between Groups 1 and 2 (14.3% vs. 3.9%; P = 0.55). Conclusion Supplementation with AT3 did not decrease time to therapeutic anti‐Xa levels, added significant cost, and was associated with increased bleeding events. Pediatr Blood Cancer 2014;61:1063–1067. © 2013 Wiley Periodicals, Inc.