Capped antithrombin III dosing is cost effective in the management of asparaginase-associated thrombosis

Pediatr Blood Cancer. 2019 Jun;66(6):e27719. doi: 10.1002/pbc.27719. Epub 2019 Mar 22.

Abstract

Asparaginase therapy induces a transient antithrombin III (ATIII) deficiency, which contributes to the risk of asparaginase-induced thrombosis. At Cincinnati Children's Hospital Medical Center, management of asparaginase-induced thrombosis includes ATIII supplementation during therapeutic anticoagulation with enoxaparin. Due to the expense associated with ATIII, a capped dosing approach for ATIII was evaluated in this population. Peak ATIII levels were obtained following capped doses to evaluate response. In this pilot evaluation, 11 patients received a total of 138 capped doses for a total cost savings of $803 782. This pilot evaluation represents the first reported analysis of capped ATIII dosing in oncology patients.

Keywords: antithrombin III; asparaginase-induced thrombosis; capped antithrombin III.

MeSH terms

  • Adolescent
  • Adult
  • Anticoagulants / administration & dosage
  • Anticoagulants / economics
  • Antithrombin III / administration & dosage
  • Antithrombin III / economics*
  • Antithrombin III / metabolism
  • Antithrombin III Deficiency / chemically induced
  • Antithrombin III Deficiency / drug therapy*
  • Antithrombin III Deficiency / economics*
  • Asparaginase / adverse effects*
  • Child
  • Cost-Benefit Analysis*
  • Drug Therapy, Combination
  • Enoxaparin / administration & dosage
  • Enoxaparin / economics*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Pilot Projects
  • Prognosis
  • Retrospective Studies
  • Thrombosis / drug therapy*
  • Thrombosis / enzymology
  • Thrombosis / pathology
  • Young Adult

Substances

  • Anticoagulants
  • Enoxaparin
  • Antithrombin III
  • Asparaginase