Prophylactic therapy with enoxaparin during L-asparaginase treatment in children with acute lymphoblastic leukemia

Ronit Elhasid, N. Lanir, R. Sharon, M. Weyl Ben Arush, C. Levin, S. Postovsky, A. Ben Barak, B. Brenner

Research output: Contribution to journalArticlepeer-review


Forty-one consecutive children with acute lymphoblastic leukemia (ALL) received prophylaxis therapy with the low molecular weight heparin (LMWH) enoxaparin during L-asparaginase treatment. Enoxaparin was given every 24 h subcutaneously at a median dose of 0.84 mg/kg per day (range, 0.45-1.33 mg/kg per day) starting at the first dose of L-asparaginase until 1 week after the last dose. Molecular analysis for thrombophilic polymorphisms documented prothrombin G20210A mutation in 3/27 (11%), homozygosity for MTHFR C677T mutation in 5/27 (18.5%, and heterozygosity for factor V Leiden mutation in 5/27 (18.5%) children. There were no thrombotic events during 76 courses of L-asparaginase in 41 patients who had received enoxaparin. One patient suffered brain infarct 7 days after enoxaparin was stopped. There were no bleeding episodes. In a historical control group of 50 ALL children who had not received prophylactic enoxaparin during L-asparaginase treatment, two had thromboembolisms (one deep vein thrombosis and one pulmonary embolism). Enoxaparin is safe and seems to be effective in prevention of thromboembolism in ALL patients during L-asparaginase therapy. This study provides pilot data for a future randomized trial of the use of LMWH during ALL therapy for the prevention of asparaginase-associated thrombotic events.

Original languageEnglish
Pages (from-to)367-370
Number of pages4
JournalBlood Coagulation and Fibrinolysis
Issue number5
StatePublished - 2001
Externally publishedYes


  • Acute lymphoblastic leukemia
  • Enoxaparin
  • L-asparaginase
  • Thrombosis


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