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DVT – enoxaparin — RACP Paediatrics MCQ

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HardCardiologyDVT – enoxaparinRACP Paediatrics

A 12-year-old with SLE and persistent antiphospholipid antibodies has a symptomatic femoral DVT confirmed by Doppler ultrasound. Renal function is normal and there is no major bleeding. Which initial anticoagulation strategy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Begin therapeutic enoxaparin under paediatric haematology care with anti-Xa titration

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

B is correct. B confirmed symptomatic DVT requires therapeutic anticoagulation; enoxaparin is the Australian paediatric LMWH with dose-finding data and is adjusted by anti-Xa monitoring under haematology care. C is prevention dosing and undertreats established thrombosis. D does not provide adequate anticoagulation for an acute venous clot. E risks transiently inadequate anticoagulation and warfarin-associated protein-D reduction before a therapeutic overlap. A reserves thrombolysis for selected acute extensive thrombosis threatening organ or limb viability, not every proximal DVT. APS affects the duration and long-term agent decision, but it does not remove the need for effective initial anticoagulation.

Reference: Royal Children’s Hospital Melbourne: Clexane guidelines for clinicians: https://www.rch.org.au/haematology/anticoagulaton_service/clexane-guidelines/