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Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

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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.

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Authors and Affiliations

  1. Division of Pediatrics, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Joe Bontadelli, Alexander Moeller & Manuela Albisetti

  2. Division of Hematology, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Markus Schmugge & Manuela Albisetti

  3. Division of Radiology, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Thomas Schraner

  4. Division of Cardiology, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Oliver Kretschmar & Urs Bauersfeld

  5. Division of Neonatology and Intensive Care, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Vera Bernet-Buettiker

Authors
  1. Joe Bontadelli
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  2. Alexander Moeller
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  3. Markus Schmugge
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  4. Thomas Schraner
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  5. Oliver Kretschmar
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  6. Urs Bauersfeld
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  7. Vera Bernet-Buettiker
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  8. Manuela Albisetti
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Corresponding author

Correspondence to Manuela Albisetti.

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Bontadelli, J., Moeller, A., Schmugge, M. et al. Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease. Intensive Care Med 33, 1978–1984 (2007). https://doi.org/10.1007/s00134-007-0718-8

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  • DOI: https://doi.org/10.1007/s00134-007-0718-8

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