Association of outcomes and anti-Xa levels in the treatment of pediatric venous thromboembolism

Jennifer L. Fan, Laura E. Roberts, Michael E. Scheurer, Donald L. Yee, Mona D. Shah, Young Na J. Lee-Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. Objective: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. Methods: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin. Results: Of 69 patients with any response to therapy, 48 (70%) had mean anti-Xa levels in the low therapeutic range and 21 (30%) had mean anti-Xa levels in the high therapeutic range. Of 20 patients with no documented response to therapy, 13 (65%) had mean anti-Xa levels in the low therapeutic range and 7 (35%) had mean anti-Xa levels in the high therapeutic range. Forty-eight (79%) of the 61 patients with low-range mean anti-Xa level had any response to therapy. Twenty-one (75%) of the 28 patients with high-range mean anti-Xa level had any response to therapy. Chi-square test (P = 0.080) and logistic regression (OR = 1.23, P = 0.70) demonstrated no significant association between mean anti-Xa range (lower vs. upper) and therapy response. Conclusions: There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.

Original languageEnglish (US)
Article numbere26629
JournalPediatric Blood and Cancer
Volume64
Issue number11
DOIs
StatePublished - Nov 2017
Externally publishedYes

Fingerprint

Venous Thromboembolism
Pediatrics
Enoxaparin
Therapeutics
Chi-Square Distribution
Thrombosis

Keywords

  • anti-Xa
  • anticoagulation
  • enoxaparin
  • pediatric hematology
  • thromboembolism
  • thrombosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Fan, J. L., Roberts, L. E., Scheurer, M. E., Yee, D. L., Shah, M. D., & Lee-Kim, Y. N. J. (2017). Association of outcomes and anti-Xa levels in the treatment of pediatric venous thromboembolism. Pediatric Blood and Cancer, 64(11), [e26629]. https://doi.org/10.1002/pbc.26629

Association of outcomes and anti-Xa levels in the treatment of pediatric venous thromboembolism. / Fan, Jennifer L.; Roberts, Laura E.; Scheurer, Michael E.; Yee, Donald L.; Shah, Mona D.; Lee-Kim, Young Na J.

In: Pediatric Blood and Cancer, Vol. 64, No. 11, e26629, 11.2017.

Research output: Contribution to journalArticle

Fan, Jennifer L. ; Roberts, Laura E. ; Scheurer, Michael E. ; Yee, Donald L. ; Shah, Mona D. ; Lee-Kim, Young Na J. / Association of outcomes and anti-Xa levels in the treatment of pediatric venous thromboembolism. In: Pediatric Blood and Cancer. 2017 ; Vol. 64, No. 11.
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abstract = "Background: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. Objective: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. Methods: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin. Results: Of 69 patients with any response to therapy, 48 (70{\%}) had mean anti-Xa levels in the low therapeutic range and 21 (30{\%}) had mean anti-Xa levels in the high therapeutic range. Of 20 patients with no documented response to therapy, 13 (65{\%}) had mean anti-Xa levels in the low therapeutic range and 7 (35{\%}) had mean anti-Xa levels in the high therapeutic range. Forty-eight (79{\%}) of the 61 patients with low-range mean anti-Xa level had any response to therapy. Twenty-one (75{\%}) of the 28 patients with high-range mean anti-Xa level had any response to therapy. Chi-square test (P = 0.080) and logistic regression (OR = 1.23, P = 0.70) demonstrated no significant association between mean anti-Xa range (lower vs. upper) and therapy response. Conclusions: There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.",
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AU - Roberts, Laura E.

AU - Scheurer, Michael E.

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AU - Shah, Mona D.

AU - Lee-Kim, Young Na J.

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N2 - Background: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. Objective: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. Methods: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin. Results: Of 69 patients with any response to therapy, 48 (70%) had mean anti-Xa levels in the low therapeutic range and 21 (30%) had mean anti-Xa levels in the high therapeutic range. Of 20 patients with no documented response to therapy, 13 (65%) had mean anti-Xa levels in the low therapeutic range and 7 (35%) had mean anti-Xa levels in the high therapeutic range. Forty-eight (79%) of the 61 patients with low-range mean anti-Xa level had any response to therapy. Twenty-one (75%) of the 28 patients with high-range mean anti-Xa level had any response to therapy. Chi-square test (P = 0.080) and logistic regression (OR = 1.23, P = 0.70) demonstrated no significant association between mean anti-Xa range (lower vs. upper) and therapy response. Conclusions: There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.

AB - Background: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. Objective: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. Methods: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin. Results: Of 69 patients with any response to therapy, 48 (70%) had mean anti-Xa levels in the low therapeutic range and 21 (30%) had mean anti-Xa levels in the high therapeutic range. Of 20 patients with no documented response to therapy, 13 (65%) had mean anti-Xa levels in the low therapeutic range and 7 (35%) had mean anti-Xa levels in the high therapeutic range. Forty-eight (79%) of the 61 patients with low-range mean anti-Xa level had any response to therapy. Twenty-one (75%) of the 28 patients with high-range mean anti-Xa level had any response to therapy. Chi-square test (P = 0.080) and logistic regression (OR = 1.23, P = 0.70) demonstrated no significant association between mean anti-Xa range (lower vs. upper) and therapy response. Conclusions: There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.

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KW - thrombosis

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