{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:34:20Z","timestamp":1786365260535,"version":"build-2736575974"},"reference-count":28,"publisher":"The Pediatric Pharmacy Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Enoxaparin is regularly used to treat thromboembolism in children. Numerous retrospective studies suggest that infants and young children require higher enoxaparin doses to achieve therapeutic anti-factor Xa (AXA) concentration of 0.5 to 1.0 units\/mL compared with adults.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This is a retrospective analysis of pre- and post-implementation of an increased initial dose of enoxaparin (1.2 mg\/kg every 12 hours) for infants between 2 and 6 months of age. The objective is to compare the number of dose adjustments needed to achieve therapeutic AXA.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 64 patients were included 30 pre- and 34 post-guideline groups. In both the pre- and post-guideline dosing groups the number of dose adjustments required to achieve therapeutic AXA when adjusted per the ACCP guidelines was a median of 1 (p = 0.35). However, the first initial AXA was 0.3 units\/mL in the pre-guideline group and 0.48 units\/mL in the post-guideline group (p = 0.07). There were no documented instances of major bleeding events in either group.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n The results support the recommendation of an increased enoxaparin starting dose for therapeutic anticoagulation in the described patient population at the study site. A large prospective study is needed to determine specific dose recommendations that will achieve therapeutic AXA concentrations for the majority of infants and children of all ages.<\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/jppt-25-00077","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:26:17Z","timestamp":1786364777000},"page":"516-522","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Enoxaparin Dosing in Infants Greater Than 2 to 6 Months of Age, a Pre and Post Quasi Experiment"],"prefix":"10.5863","volume":"31","author":[{"given":"Colleen Jamie","family":"Djordjevich","sequence":"first","affiliation":[{"name":"Department of Pharmacy (CJD, CC), Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Cloyd","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (CJD, CC), Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Wysocki","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (EW), Geisinger Medical Center, Danville, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat O.","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Center for Biostatistics, Department of Biomedical Informatics (VOY), College of Medicine, The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilmarie","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology\/Blood and Marrow Transplantation (VR), Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"5","key":"JPPT-25-00077-b01","series-title":"Blood","first-page":"335","article-title":"Treatment of venous thromboembolism in pediatric patients","volume":"135","author":"Witmer","year":"2020","unstructured":"Witmer CM, Raffini L. Treatment of venous thromboembolism in pediatric patients. Blood. 2020;135(5):335\u2013343."},{"key":"JPPT-25-00077-b02","series-title":"Front Pediatr","first-page":"198","article-title":"Pediatric hospital acquired venous thromboembolism","volume":"5","author":"Witmer","year":"2017","unstructured":"Witmer CM, Takemoto CM. Pediatric hospital acquired venous thromboembolism. Front Pediatr. 2017;5:198."},{"issue":"3","key":"JPPT-25-00077-b03","series-title":"Pediatrics","first-page":"e2021054649","article-title":"The continued rise of venous thromboembolism across US children\u2019s hospitals","volume":"149","author":"O\u2019Brien","year":"2022","unstructured":"O\u2019Brien SH, Stanek JR, Witmer CM, Raffini L. The continued rise of venous thromboembolism across US children\u2019s hospitals. Pediatrics. 2022;149(3):e2021054649."},{"key":"JPPT-25-00077-b04","series-title":"J Pediatr","first-page":"175","article-title":"Incidence trends and mortality from childhood venous thromboembolism: a population-based cohort study","volume":"172","author":"Sabapathy","year":"2016","unstructured":"Sabapathy CA, Djouonang TN, Kahn SR, et al. Incidence trends and mortality from childhood venous thromboembolism: a population-based cohort study. J Pediatr. 2016;172:175\u2013180."},{"issue":"suppl 2","key":"JPPT-25-00077-b05","series-title":"Chest","first-page":"e737S","article-title":"Antithrombotic therapy in neonates and children: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"Monagle","year":"2012","unstructured":"Monagle P, Chan AKC, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(suppl 2):e737S\u2013e801S."},{"key":"JPPT-25-00077-b06","article-title":"Lexi-Drugs. Lexicomp","unstructured":"Enoxaparin. Lexi-Drugs. Lexicomp. Riverwoods, IL: Wolters Kluwer Health, Inc. Accessed July 23, 2025. https:\/\/online.lexi.com"},{"issue":"10","key":"JPPT-25-00077-b07","series-title":"Blood Adv","first-page":"2587","article-title":"American Society of Hematology\/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients","volume":"9","author":"Monagle","year":"2025","unstructured":"Monagle P, Azzam M, Bercovitz R, et al. American Society of Hematology\/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients. Blood Adv. 2025;9(10):2587\u20132636."},{"issue":"9","key":"JPPT-25-00077-b08","series-title":"J Thromb Haemost","first-page":"1950","article-title":"Population pharmacokinetics of enoxaparin in infants, children and adolescents during secondary thromboembolic prophylaxis: a cohort study","volume":"8","author":"Trame","year":"2010","unstructured":"Trame MN, Mitchell L, Kr\u00fcmpel A, et al. Population pharmacokinetics of enoxaparin in infants, children and adolescents during secondary thromboembolic prophylaxis: a cohort study. J Thromb Haemost. 2010;8(9):1950\u20131958."},{"issue":"7","key":"JPPT-25-00077-b09","series-title":"Clin Pharmacokinet","first-page":"999","article-title":"Characterizing enoxaparin\u2019s population pharmacokinetics to guide dose individualization in the pediatric population","volume":"63","author":"Carre\u00f1o","year":"2024","unstructured":"Carre\u00f1o FO, Gerhart JG, Helfer VE, et al. 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