Conclusions
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. Secondarily, it was noted that levels were potentially drawn too often without clinical benefit. An abundance of monitoring increases healthcare costs and is inconvenient for the patient without an essential clinical benefit. Although a level after the first week of a therapeutic enoxaparin dose may provide benefit, it is unclear if the confirmatory or monthly levels provide any clinical or safety benefit. Further prospective studies are warranted to better risk stratify which children require the multiple anti-Xa levels currently checked on all patients. We believe there is clinical equipoise to conduct a prospective study comparing the methods of checking 2 levels (before the 3th dose and then at one week) versus checking our current standard 4 levels, which in the end becomes an average of 7.5 levels checked for 2 dose changes for a 6-12 week treatment course.