Impact of Pharmacist-To-Dose Enoxaparin in Pediatric Patients.

Abstract

Objective: Variations in pharmacokinetics necessitate monitoring anti-Xa concentrations for optimal anticoagulation in pediatric patients receiving enoxaparin for the prophylaxis or treatment of venous thromboembolism. Pharmacists play an essential role through pharmacist-to-dose (PTD) protocols. This study aims to assess the impact of pharmacist involvement by comparing rates of achieving target anti-Xa concentrations before and after implementation of the PTD protocol in a pediatric population.

Methods: Medical records were queried for patients 18 years old and younger who received enoxaparin as an inpatient at West Virginia University Medicine Children's Hospital from January 2016 to September 2023. Indication, dosing, and administration of enoxaparin were assessed. Anti-Xa concentrations were evaluated for appropriate timing and goal range. Secondary outcomes included the number of anti-Xa concentrations drawn, the number of enoxaparin dose adjustments, the rate of accurately drawn anti-Xa concentrations, the rate of following guideline recommended enoxaparin dosing on initiation, and the time to goal anti-Xa concentration.

Results: There was no difference in the rate of anti-Xa concentrations that were in goal before and after the implementation of a pharmacist-led enoxaparin dosing protocol. The frequency of concentrations drawn appropriately was higher, and the time to goal was shorter after the implementation of the PTD protocol, although this difference was not statistically significant.

Conclusions: There was no difference in the rate of anti-Xa concentrations that were in goal between groups. This likely stemmed from the use of the same dose adjustment guideline among both groups. This underscores the equal quality of care provided by pharmacists in achieving optimal anticoagulation and positive outcomes.