REVIEW ARTICLE Enoxaparin for neonatal thrombosis: A call for a higher dose for neonates Janet I. Malowany a , Paul Monagle b,c , David C. Knoppert a , David S.C. Lee a , John Wu d , Patricia McCusker e , M. Patricia Massicotte f , Suzan Williams g , Anthony K.C. Chan h, ⁎ for Canadian Paediatric Thrombosis and Hemostasis Network a Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada N6A 5C1 b Department of Haematology, Royal Children's Hospital, University of Melbourne, Australia c Department of Pathology, University of Melbourne, Australia d BC Children's Hospital, Vancouver, Canada e CancerCare Manitoba, Winnipeg, Canada f Stollery Children's Hospital, Edmonton, Canada g The Hospital for Sick Children, Toronto, Canada h Department of Pediatrics, McMaster University, Hamilton, Canada Received 6 November 2007; accepted 15 November 2007 Available online 18 January 2008 Abstract Introduction: Enoxaparin is the current anticoagulant of choice for neonatal thrombo- sis. Present neonatal treatment guidelines of 1.5 mg/kg every 12 hours (q12 h) are extrapolated primarily from an earlier study with 9 infants less than 2 months of age. More recent studies indicate an increased dose requirement for neonates. Materials and methods: Relevant data from articles and abstracts were identified by searching MEDLINE and pediatric and hematology conference proceedings. Results: Publications between 1996 and 2007 included 8 papers, 4 abstracts and 1 review article with primary research documenting enoxaparin use in 240 neonates. The mean maintenance dose of enoxaparin ranged from 1.48 to 2.27 mg/kg q12 h for all infants, but was higher for preterm neonates at 1.9–2.27 mg/kg q12 h. The efficacy of enoxaparin, causing either complete or partial resolution was between 59 and 100%. Minor side effects were common and adverse events (major bleeding) occurred in 12 patients (0–19%). ⁎ Corresponding author. McMaster University, Department of Pediatrics, Division of Hematology/Oncology, 1200 Main Street West, Room 3N27, Hamilton, ON, Canada L8N 3Z5. Tel.: +1 905 521 2100x73428; fax: +1 905 575 2646. E-mail address: akchan@mcmaster.ca (A.K.C. Chan). www.elsevier.com/locate/thromres 0049-3848/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.thromres.2007.11.009 Thrombosis Research (2008) 122, 826–830