Coagulation monitoring correlation with heparin dose in pediatric extracorporeal life support.

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  • Additional Information
    • Source:
      Publisher: SAGE Publications Country of Publication: England NLM ID: 8700166 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1477-111X (Electronic) Linking ISSN: 02676591 NLM ISO Abbreviation: Perfusion Subsets: MEDLINE
    • Publication Information:
      Publication: London : SAGE Publications
      Original Publication: [London] : Edward Arnold, [c1986-
    • Subject Terms:
      Blood Coagulation Tests/*methods ; Extracorporeal Membrane Oxygenation/*methods ; Heparin/*therapeutic use; Child, Preschool ; Female ; Heparin/administration & dosage ; Heparin/pharmacology ; Humans ; Infant ; Infant, Newborn ; Male ; Retrospective Studies
    • Abstract:
      Objectives: Extracorporeal Life Support (ECLS) risks thrombotic and hemorrhagic complications. Optimal anti-coagulation monitoring is controversial. We compared coagulation tests evaluating the heparin effect in pediatric ECLS.
      Methods: A retrospective study of children (<18yrs) undergoing ECLS over 12 months in a tertiary pediatric intensive care unit (PICU). Variables included anti-Factor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), activated clotting time (ACT) and thromboelastogram (TEG ® 6s) parameters: ratio and delta reaction (R) times (the ratio and difference, respectively, between R times in kaolin assays with and without heparinase). Test results were correlated with unfractionated heparin infusion rate (IU/kg/hr) at the time of sampling. Mean test results of each ECLS run were evaluated according to the presence/absence of complications.
      Results: Thirty-two ECLS runs (31 patients) generated 695 data-points for correlation. PICU mortality was 22% and the thrombotic complication rate was 66%. The proportion of variation in coagulation test results explained by heparin dose was 13.3% for anti-Xa, 11.9% for ratio R time, and 9.9% for delta R time, compared with <1% for ACT and aPTT. Incorporating individual variation, age and antithrombin activity in a model with heparin dose explained less than 50% of the variation in test results. Correlation varied according to age, day of ECLS run and between individuals, with parallel dose-response lines noted between patients. Significantly lower mean anti-Xa was observed in PICU non-survivors and runs with thrombosis.
      Conclusion: Lower anti-Xa was observed in ECLS runs with complications. Although absolute results from anti-Xa and TEG6 ® s showed the best correlation with heparin dose, a large proportion of variation in results was unexplained by heparin, while dose response was similar between individuals. Population pharmacokinetic/pharmacodynamic modelling is required, as well as prospective trials to delineate the superior means of adjusting heparin therapy to prevent adverse clinical outcomes.
    • Contributed Indexing:
      Keywords: blood coagulation tests; child; extracorporeal membrane oxygenation; heparin; intensive care units; pediatric; thromboelastography
    • Accession Number:
      9005-49-6 (Heparin)
    • Publication Date:
      Date Created: 20170712 Date Completed: 20180627 Latest Revision: 20220410
    • Publication Date:
      20221213
    • Accession Number:
      10.1177/0267659117720494
    • Accession Number:
      28693359