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PEDIATRIC ANTICOAGULATION MEDICATION USE EVALUATION
Mathew J*
Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467
Pharmacologic management of pediatric thromboembolic disease represents a significant challenge in infants and children. The dynamic hemostatic system of the pediatric population renders interactions with antithrombotic agents that differ from adults. Current anticoagulation practice guidelines set forth by the American College of Chest Physicians are based on limited pediatric data and extrapolations from adult dosing recommendations. The Children’s Hospital at Montefiore (CHAM) is a 130 bed hospital serving children and adolescents. The lack of institution-specific guidelines for the use of these high-risk agents at CHAM necessitates the assessment of current medication use practices. The goal of this medication-use evaluation is to determine how well the prescribing and monitoring of enoxaparin and warfarin in pediatric patients at CHAM adheres to current practice guidelines from the American College of Chest
Physicians. A retrospective chart review will be conducted to gather data on patients treated with enoxaparin and/or warfarin and monitored for anti-factor Xa levels and/or international normalized ratio (INR). Patient charts from a six month period will be reviewed. Data to be collected include demographics (i.e. weight, height, age, and gender), pertinent medical history, indication for enoxaparin and/or warfarin, dosing regimen (including dose and frequency), anticoagulation and other pertinent laboratory values, and patient counseling documentation.
Patients 18 years of age and older will be excluded from the study. Patients prescribed enoxaparin with eGFR less than 30 mL/min will be evaluated separately. The results of this evaluation may elucidate potential medication safety process improvement strategies, including ways to improve overall prescribing and monitoring practices.
Potential areas to increase pharmacist involvement include optimizing initial dosing regimens and dosing adjustments as recommended by the practice guidelines, providing education to medical practitioners and nursing staff, and providing patient counseling. This study has been approved by the Montefiore
Institutional Review Board. There are no physical, psychological, or social risks anticipated with this research. Only investigators involved in this review will have privileges to review data collected, and it will be stored without patient identifiers for the purpose of confidentiality.