Intravenous Enoxaparin in Pediatric Burn Patients: A Case Series

• Published in: The journal of pediatric pharmacology and therapeutics 2019-09, Vol.24 (5), p.456-461
• Main Authors: Streetz, Vonya N., Patatanian, Leslie K.
• Format: Article
• Language: English
• Subjects: Case Reports
• ISSN: 1551-6776; 2331-348X
• DOI: 10.5863/1551-6776-24.5.456

Patients with acute burns experience a hypercoagulable state that may necessitate the use of anticoagulants to prevent the complications of venous thromboembolism (VTE). Enoxaparin is a low molecular weight heparin that is commonly used for this purpose; however, the traditional SC route of administration poses potential limitations in the pediatric burn population. These include pain upon injection, increased anxiety, erroneous absorption and distribution, and difficulty in finding an administration site when burns encompass a large percentage of body surface area. As a result, the IV route of administration may be preferable in these patients. To date, a limited number of studies in critically ill pediatric patients have been performed. In this report, we present a case series of 3 pediatric burn patients who initially received SC enoxaparin and were transitioned to IV enoxaparin for VTE prophylaxis. The patients were 2, 8, and 10 years old. Burn involvement ranged from 8% to 75% total body surface area, and all patients had central line access. Adequate prophylactic low molecular weight heparin anti-Xa peak concentrations (0.1–0.3 international units/mL) were achieved with IV doses ranging from 0.35 to 0.5 mg/kg administered every 12 hours. No adverse effects, major bleeding events, or treatment failures occurred.