{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:17:10Z","timestamp":1779927430216,"version":"3.53.1"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Enoxaparin is an anticoagulant used for pharmacologic thromboprophylaxis in pediatrics. Enoxaparin pharmacokinetics can be altered in the setting of obesity. Optimal enoxaparin dosing for thromboprophylaxis in children with obesity remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A retrospective review was conducted of pediatric patients who weighed \u226560\u00a0kg with BMI\u00a0\u2265\u00a095th percentile, received enoxaparin for thromboprophylaxis, and had at least one appropriately drawn anti\u2010factor Xa\u00a0(anti\u2010Xa) from 2013 to 2022. Anti\u2010Xa levels were reviewed for patients initially treated with enoxaparin 30\u00a0mg every 12\u00a0h. The average daily enoxaparin dose required to achieve an anti\u2010Xa of 0.2\u20130.4 unit\/mL, which was stratified by BMI percentile and weight, was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 116 patients (median age 15.8 years) included for analysis, 106 patients were initially treated with enoxaparin 30\u00a0mg every 12\u00a0h. Anti\u2010Xa levels were\u00a0&lt;0.2 unit\/mL in 53% of patients with BMI\u00a0&gt;\u00a099th percentile and 54% of patients\u00a0&gt;100\u00a0kg. Ninety\u2010one patients had at least one anti\u2010Xa 0.2\u20130.4\u00a0unit\/mL with an average daily enoxaparin dosing of 66\u00a0mg. When stratified by severity of obesity, higher doses were required to attain an anti\u2010Xa 0.2\u20130.4 unit\/mL in patients with BMI\u00a0&gt;\u00a099th percentile compared with those with 95th\u201399th percentile (67.8\u00a0\u00b1\u00a015.7 vs. 62\u00a0\u00b1\u00a05.6\u00a0mg\/day, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.01). Patients\u00a0&gt;\u00a0100\u00a0kg required significantly higher dose than those \u2264100\u00a0kg (69.1\u00a0\u00b1\u00a015.5 vs 61.2\u00a0\u00b1\u00a07.3\u00a0mg\/day, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased initial dosing and\/or anti\u2010Xa level monitoring should be considered in adolescents with severe obesity receiving enoxaparin thromboprophylaxis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30942","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T04:17:25Z","timestamp":1710476245000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Enoxaparin thromboprophylaxis in hospitalized obese pediatric patients"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6653-2868","authenticated-orcid":false,"given":"Juwon","family":"Yim","sequence":"first","affiliation":[{"name":"Department of Pharmacy Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrin","family":"Jahan","sequence":"additional","affiliation":[{"name":"Advanced Analytics and Outcomes Team\/ Information Services and Technology Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay","family":"Braykov","sequence":"additional","affiliation":[{"name":"Advanced Analytics and Outcomes Team\/ Information Services and Technology Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina D.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-0974","authenticated-orcid":false,"given":"Gary M.","family":"Woods","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA"},{"name":"Department of Pediatrics Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00068"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-1386"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15060"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2022.2052"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2014.886315"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2308"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-3282"},{"issue":"5","key":"e_1_2_7_9_1","first-page":"1369","article-title":"Parenteral anticoagulants\u2014Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence\u2010based clinical practice guidelines","volume":"141","author":"Garcia DA","year":"2012","journal-title":"Chest"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1381\/096089202321144522"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L194"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028018768449"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.36518\/2689-0216.1464"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.10.087"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001193"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-2329C"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4068"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy066"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-0746"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-019-04135-5"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-015-1630-x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2618"}],"container-title":["Pediatric Blood &amp; 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