Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity

• Published in: Annals of Pharmacotherapy 2021-05, Vol.55 (5), p.666-676
• Main Authors: Garner, Michael P., Onuoha, Chimnonso P., Fenn, Norman E.
• Format: Article
• Language: English
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028020955029

Objective: The objective of this study is to comprehensively review the efficacy and safety data of low-molecular-weight heparins (LMWHs) and fondaparinux in pediatric patients with obesity. Data Sources: A comprehensive literature search of PubMed, SCOPUS, CINAHL, Academic Search Complete, PsycInfo, Cochrane Library, and Web of Science databases was conducted (1900 to July 2020). Search terms utilized included LMWH, low-molecular-weight heparin, enoxaparin, dalteparin, tinzaparin, fondaparinux, pediatric, child, children, obese, obesity, overweight. No limits or timeline restrictions were imposed. Study Selection and Data Extraction: Studies that reported pediatric patients with described overweight or obesity and utilized LMWHs or fondaparinux were considered. Data Synthesis: Of 207 studies screened, 12 were included. Average dose reductions of 12.9% to 37.3% from the starting dose were observed with treatment indications of enoxaparin and increased up to 27.3% for prophylactic indications. Trends could not be concluded in the dalteparin and fondaparinux studies. Four thrombotic and 15 bleeding events were reported in the studies. Relevance to Patient Care and Clinical Practice: Pediatric patients with obesity may initially be underdosed or overdosed with enoxaparin compared with children with healthy body weight, depending on the indication. Conclusion: Pediatric patients with obesity may benefit from proactively adjusting enoxaparin dosing on initiation of therapy. Further studies are needed for dalteparin and fondaparinux in these populations. Clinical controversy exists with the relevance of monitoring these high-risk medications for therapeutic and prophylactic indications. Thrombotic and hemorrhagic events were similar to reported adult outcomes.