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Evaluation of the age-dependent dosing recommendations for the administration of daily tinzaparin in children with thrombosis

Lookup NU author(s): Dr Kate Musgrave, Kat Webber, Dr Peter Avery, Dr Tina Biss

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley, 2017.

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Abstract

BACKGROUND:Recommended starting doses of tinzaparin for the treatment of thrombosis in children have not previously been validated. There are few data to support efficacy and safety of once-daily tinzaparin dosing in children with thrombosis.OBJECTIVES:This study investigated using tinzaparin for the treatment of childhood thrombosis. It aimed to evaluate the age-dependent dosing recommendations and to define outcomes in terms of efficacy and safety.METHODS:This was a retrospective cohort study of children aged 0-<16 years treated for thrombosis at a large teaching hospital in the United Kingdom between 2008 and 2015. Medical records were reviewed to evaluate tinzaparin dosing, anti-factor Xa levels and patient outcomes.RESULTS:79 children were identified to have received tinzaparin. Dosing information was available for 57. Younger children required higher doses to reach a therapeutic level. Therapeutic dose requirement varied within age groups, supporting the use of anti-factor Xa monitoring. Over a median follow up of 35 months, there were 13 (16%) bleeding episodes (2 major; 7 clinically relevant but non-major; 4 minor). There were 2 (3%) recurrent episodes of thrombosis. Children were treated for a median duration of 3 months and the majority (86%) remained on tinzaparin for the duration of their anticoagulant therapy.CONCLUSION:Once-daily tinzaparin is a safe and effective treatment of childhood thrombosis with rates of recurrence and bleeding similar to other anticoagulants used in children. The recommended starting doses are appropriate but anti-factor Xa monitoring may be required due to inter-individual variability in the therapeutic dose requirement. This article is protected by copyright. All rights reserved.


Publication metadata

Author(s): Musgrave KM, Webber K, Murphy P, Avery P, Biss TT

Publication type: Article

Publication status: Published

Journal: Journal of Thrombosis and Haemostasis

Year: 2017

Volume: 15

Issue: 12

Pages: 2361-2366

Print publication date: 01/12/2017

Online publication date: 04/10/2017

Acceptance date: 19/09/2017

ISSN (print): 1538-7933

ISSN (electronic): 1538-7836

Publisher: Wiley

URL: https://doi.org/10.1111/jth.13856

DOI: 10.1111/jth.13856

PubMed id: 28976613


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