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Treatment of Deep Vein Thrombosis With Enoxaparin in Pediatric Cancer Patients Receiving Chemotherapy

Department of Pediatrics, Section of Pediatric Hematology-Oncology, University of Arkansas for Medical Sciences at Arkansas Children's Hospital, 800 Marshall St. Slot 512-10, Little Rock, AR

Robert L. Saylors, MD

Department of Pediatrics, Section of Pediatric Hematology-Oncology, University of Arkansas for Medical Sciences at Arkansas Children's Hospital, 800 Marshall St. Slot 512-10, Little Rock, AR

C. Suzanne Saccente, MD

Department of Pediatrics, Section of Pediatric Hematology-Oncology, University of Arkansas for Medical Sciences at Arkansas Children's Hospital, 800 Marshall St. Slot 512-10, Little Rock, AR

David L. Becton, MD

Department of Pediatrics, Section of Pediatric Hematology-Oncology, University of Arkansas for Medical Sciences at Arkansas Children's Hospital, 800 Marshall St. Slot 512-10, Little Rock, AR

There are few data regarding the use of enoxaparin in children undergoing myelosuppressive therapy for malignancies even though thrombosis is a known risk in pediatric patients with malignancies. Low-molecular-weight heparin such as enoxaparin has become widely used in adult patients with thrombosis. The purpose of this study was to review the utilization of low-molecular-weight heparin, enoxaparin (Lovenox), in children with cancer at our institution who had thrombosis while undergoing myelosuppressive chemotherapy. In particular we were interested in the efficacy of enoxaparin in these patients, and in whether these children were able to continue their chemotherapy without adjustment or interruption secondary to bleeding complications. We conducted a retrospective review from 1999 through April 1, 2004. Seven patients (4—17 years of age) were identified. Diagnosis included B-precursor acute lymphoblastic leukemia (ALL) (n=three), T-ALL, Hodgkin's disease, anaplastic large cell lymphoma, and rhabdomyosarcoma (n=one each). Six patients had a deep vein thrombus (DVT) or clot of the vena cava. One of these six patients also had a pulmonary embolus. One patient presented with manifestations of a unilateral cerebral vascular accident without evidence of DVT. Most patients were screened for known hypercoaguable abnormalities. Treatment was enoxaparin, 1—1.5 mg/kg/dose twice daily to maintain a heparin anti-Xa level of 0.5—1.5 IU/mL till clot resolution. The dose was then decreased to daily for a total of 3—6 months of therapy. All patients had resolution of their thrombosis within 1—2 months of initiation of enoxaparin, and none required delays or dose reduction of their chemotherapy regimens while on anticoagulation, though some were supported by blood and platelet transfusions. Enoxaparin was safely administered to this series of seven patients for thrombotic complications in children undergoing cancer chemotherapy.

Key Words: enoxaparin • DVT • pediatric malignancy.

Clinical and Applied Thrombosis/Hemostasis, Vol. 13, No. 2, 161-165 (2007)
DOI: 10.1177/1076029606298989


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