Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review
The rising incidence of venous thromboembolism (VTE) in neonates has led to increased use of low-molecular-weight heparins (LMWHs), but optimal dosages remain uncertain. A serious adverse effect of LMWHs is major bleeding. Given the vulnerability of neonates to major bleeding, we aimed to review the...
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Elsevier
2024-10-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037924002966 |
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| author | Marieke Verweij Mirjam M. van Weissenbruch Irene L.M. Klaassen |
| author_facet | Marieke Verweij Mirjam M. van Weissenbruch Irene L.M. Klaassen |
| author_sort | Marieke Verweij |
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| description | The rising incidence of venous thromboembolism (VTE) in neonates has led to increased use of low-molecular-weight heparins (LMWHs), but optimal dosages remain uncertain. A serious adverse effect of LMWHs is major bleeding. Given the vulnerability of neonates to major bleeding, we aimed to review therapeutic and prophylactic LMWH dosages to achieve target anti-factor Xa ranges of 0.5 and 1.0 U/mL and 0.1 and 0.4 U/mL, respectively. Our secondary aim was to assess the safety and efficacy of LMWHs in neonates. A systematic review of all published studies between 1996 and 2023 that pertained to the dosing, safety, or efficacy of LMWH in preterm and term neonates. Studies were identified through the Medline database. Data on LMWH dosages, bleeding events, resolution and recurrence, and anti-factor Xa levels were analyzed. A total of 38 studies involving 1145 neonates were included. To achieve a therapeutic or prophylactic target range, weight-adjusted initial dosages of LMWH had to be increased by 21% particularly in premature neonates. During therapeutic therapy, major bleeding occurred in 4.1% and minor bleeding in 7.1%. During prophylactic therapy, 11.4% experienced major bleeding and 17.1% minor bleeding. With therapeutic dosages, 55.8% achieved complete VTE resolution. Additionally, 68.5% of neonates initially failed to achieve therapeutic anti-factor Xa levels, persisting in 29.4% despite dose adjustments. A higher initial therapeutic dosage of LMWHs may be needed in neonates. In addition, the patient’s gestational age must be considered in the dosing strategy to optimize outcomes. Although this must be weighed against bleeding risk at an individual level. |
| format | Article |
| id | doaj-art-9295dba84ed747ac8fea75c4afa9dff9 |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-9295dba84ed747ac8fea75c4afa9dff92024-11-23T06:31:27ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792024-10-0187102601Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic reviewMarieke Verweij0Mirjam M. van Weissenbruch1Irene L.M. Klaassen2Department of Pediatrics—Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the NetherlandsDepartment of Pediatrics—Neonatology, Emma Children’s Hospital, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, the NetherlandsDepartment of Pediatrics—Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Correspondence Irene L.M. Klaassen, Department of Pediatrics—Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.The rising incidence of venous thromboembolism (VTE) in neonates has led to increased use of low-molecular-weight heparins (LMWHs), but optimal dosages remain uncertain. A serious adverse effect of LMWHs is major bleeding. Given the vulnerability of neonates to major bleeding, we aimed to review therapeutic and prophylactic LMWH dosages to achieve target anti-factor Xa ranges of 0.5 and 1.0 U/mL and 0.1 and 0.4 U/mL, respectively. Our secondary aim was to assess the safety and efficacy of LMWHs in neonates. A systematic review of all published studies between 1996 and 2023 that pertained to the dosing, safety, or efficacy of LMWH in preterm and term neonates. Studies were identified through the Medline database. Data on LMWH dosages, bleeding events, resolution and recurrence, and anti-factor Xa levels were analyzed. A total of 38 studies involving 1145 neonates were included. To achieve a therapeutic or prophylactic target range, weight-adjusted initial dosages of LMWH had to be increased by 21% particularly in premature neonates. During therapeutic therapy, major bleeding occurred in 4.1% and minor bleeding in 7.1%. During prophylactic therapy, 11.4% experienced major bleeding and 17.1% minor bleeding. With therapeutic dosages, 55.8% achieved complete VTE resolution. Additionally, 68.5% of neonates initially failed to achieve therapeutic anti-factor Xa levels, persisting in 29.4% despite dose adjustments. A higher initial therapeutic dosage of LMWHs may be needed in neonates. In addition, the patient’s gestational age must be considered in the dosing strategy to optimize outcomes. Although this must be weighed against bleeding risk at an individual level.http://www.sciencedirect.com/science/article/pii/S2475037924002966efficacylow-molecular-weight heparinneonatessafetyvenous thromboembolic disease |
| spellingShingle | Marieke Verweij Mirjam M. van Weissenbruch Irene L.M. Klaassen Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review Research and Practice in Thrombosis and Haemostasis efficacy low-molecular-weight heparin neonates safety venous thromboembolic disease |
| title | Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review |
| title_full | Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review |
| title_fullStr | Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review |
| title_full_unstemmed | Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review |
| title_short | Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review |
| title_sort | balancing safety and efficacy of low molecular weight heparins in neonates a systematic review |
| topic | efficacy low-molecular-weight heparin neonates safety venous thromboembolic disease |
| url | http://www.sciencedirect.com/science/article/pii/S2475037924002966 |
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