Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

Abstract

Objective To investigate efficacy and safety of enoxaparin for catheter-related arterial thrombosis in infants with congenital heart disease. Design Prospective observational study. Setting Pediatric Intensive Care and Cardiology Unit at the University Children's Hospital of Zurich. Patients A cohort of 32 infants aged 0–12 months treated with enoxaparin for catheter-related arterial thrombosis from 2002 to 2005. Measurements Dose requirements of enoxaparin, resolution of thrombosis by Doppler ultrasound, and bleeding complications. Results Catheter-related arterial thrombosis was located in the iliac/femoral arteries in 31 (97%) infants and aorta in 1 infant, and was related to indwelling catheters and cardiac catheterization in 17 (53%) and 15 (47%) cases, respectively. Newborns required increased doses of enoxaparin to achieve therapeutic anti-FXa levels (mean 1.62 mg/kg per dose) compared with infants aged 2–12 months (mean 1.12 mg/kg per dose; p = 0.0002). Complete resolution of arterial thrombosis occurred in 29 (91%) infants at a mean of 23 days after initiation of enoxaparin therapy. Partial or no resolution was observed in 1 (3%) and 2 (6%) infants, respectively, at a mean follow-up time of 4.3 months. Bleeding complications occurred in 1 (3%) infant. Conclusion Enoxaparin is efficient and safe for infants with congenital heart disease and catheter-related arterial thrombosis, possibly representing a valid alternative to the currently recommended unfractionated heparin.