Clinical experiences with low-molecular weight heparins in pediatric patients

The courses of 79 children (2 weeks to 19 years old) treated with two diffe rent low-molecular weight heparins (LMWHs)-nadroparin (n = 66) and enoxapar in (n = 13) - were retrospectively analysed. In 62 patients, LMWHs were giv en for short-term prophylaxis (1-2 weeks) during immobilization after surge ry or trauma. Thirteen children with thromboembolic events received long-te rm prophylaxis with LMWHs for 2-18 months-six after thrombolytic therapy an d seven after therapy with unfractionated heparin (UFH). Because of thrombo embolic events, four patients were initially treated with LMWHs. In all pat ients with short-term prophylaxis, no thrombosis occurred. After thrombolyt ic therapy, three children had no reocclusion, two had no thrombus appositi on and one had complete recanalization. In the seven patients treated with LMWHs after UFH, four had no reocclusion, two had recanalization and one ha d reocclusion. In all patients receiving LMWHs for initial treatment of thr ombosis, no thrombus apposition, but also no recanalization, occurred. For short-term prophylaxis, nadroparin was used independent of the body weight and without determination of anti-factor Xa. (anti-FXa) activity. Long-term prophylaxis was given mainly as doses of 45-100 anti-FXa U/kg resulting in anti-FXa activities between 0.2 and 0.4 U/ml. For treatment of thrombosis, doses of 200-300 anti-FXa U/kg corresponded to 0.5-1.0 anti-FXa U/ml. Side effects-slight gastrointestinal bleeding and temporary reversible hair los s-were seen in two patients. In conclusion, LMWHs proved to be efficious an d safe especially in prophylaxis of thromboembolic events in children. (C) 2001 Elsevier Science Ltd. All rights reserved.