Enoxaparin Population Pharmacokinetics in the First Year of Life

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Abstract

Aims:

Enoxaparin dosing requirements in the first year of life can be highly variable. Characterization of pharmacokinetics in this patient population can assist in dosing.

Methods:

Patients less than 1 year postnatal age who received enoxaparin and had an anti–factor Xa activity level drawn as inpatients were identified through the pharmacy database over a 5-year period. Patients on renal replacement therapy or with hyperbilirubinemia were excluded. Data collection included demographic variables, indication for enoxaparin, enoxaparin doses, anti–factor Xa activity levels, serum creatinine, hemoglobin, hematocrit, platelet count, and urine output over the previous 24 hours. Population pharmacokinetic analysis was performed with NONMEM.

Results:

A total of 182 patients [male 50%, median 100 days postnatal age (range: 4–353 days)] met the study criteria. Patients received median 22 doses (range: 1–526) at a mean starting dose of 1.38 ± 0.43 mg/kg with median 5 (range: 1–56) anti–factor Xa activity levels measured. A 1-compartment proportional and additive error model best fits the data. Allometrically scaled weight significantly decreased the objective function value, as did serum creatinine on clearance, and postmenstrual age (PMA) on volume of distribution. When evaluated graphically, dosing based on PMA appeared to have less variability as compared to postnatal age–based dosing.

Conclusions:

Dosing of enoxaparin in infants younger than 1 year should incorporate PMA.

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