Background A venous thromboembolism (VTE) is a blood clot that occurs secondary to vessel wall injury often from a central line insertion. Enoxaparin is often considered a first line treatment in pediatrics for VTE due to its favorable kinetic profile. Enoxaparin monitoring for pediatric patients is accomplished through anti-Xa monitoring although a correlation of efficacy and safety as yet to be established. The objective of this study is to evaluate covariates in pediatric patients to determine which variables are most likely to be associated with enoxaparin dose changes. Methods A single center, retrospective chart review was conducted in pediatric patients treated with enoxaparin for VTE over a 10-year period were assessed to determine covariates that lead to dose changes based off anti-Xa levels. Secondary outcomes described monitoring patterns at the University of New Mexico Children’s Hospital. Results Sixty eight patients met inclusion criteria in which results showed that patients aged 2-5.9 months (p=0.026), critical care status (p=0.009), and of Native American ethnicity (p = 0.016) were likely to have an enoxaparin dose change at least once during their treatment regimen. The mean number of levels drawn were 7.5 per patient and doses were not frequently changed based off a confirmatory lab draw. However, many doses were adjusted based off the week 1 post therapeutic level. Conclusion In conclusion, we found that patients of Native American ethnicity, younger than 6 months, and those admitted to the pediatric intensive care unit were likely to have dose changes based on anti-Xa levels.