Use of Heparin Derivatives in Overweight and Obese Pediatric Patients

There is a high prevalence of childhood obesity which is a risk factor for developing thromboembolic events. Here we review the efficacy and safety data available of for heparin derivatives in the overweight or obese pediatric patients. A comprehensive literature search of 7 databases were conducted in a systematic approach. 11 of 180 studies were included. 9 studies evaluated the use of enoxaparin, 1 evaluated dalteparin, and 1 described fondaparinux in a case study. Dose adjustments were made to achieve therapeutic anti-factor Xa measurements, but was inconsistently performed. Dose reductions of 12.9-37.3% from baseline occurred with the treatment studies of enoxaparin, and a 27.3% increase from prophylactic indications was noted. 5 thromboembolic events were seen. 15 bleeding events were reported, 1 of which required surgery and blood products. Trends couldn't be made with the other 2 products due to limited evidence. Heparin derivatives may need to be initiated at modified doses.