Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in heparinized pediatric patients after cardiac surgery.

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  • Additional Information
    • Source:
      Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: St. Louis, MO : Mosby
      Original Publication: St. Louis.
    • Subject Terms:
      Partial Thromboplastin Time*; Anticoagulants/*adverse effects ; Blood Coagulation/*drug effects ; Cardiac Surgical Procedures/*adverse effects ; Drug Monitoring/*methods ; Factor Xa/*metabolism ; Heart Defects, Congenital/*surgery ; Heparin/*adverse effects ; Postoperative Hemorrhage/*diagnosis ; Thrombosis/*prevention & control; Age Factors ; Anticoagulants/administration & dosage ; Biomarkers/blood ; Child, Preschool ; Heparin/administration & dosage ; Humans ; Infant ; Postoperative Hemorrhage/blood ; Postoperative Hemorrhage/chemically induced ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; Thrombosis/blood ; Thrombosis/diagnosis ; Thrombosis/etiology ; Time Factors ; Treatment Outcome
    • Abstract:
      Objectives: Anticoagulation with unfractionated heparin (UFH) after pediatric cardiac surgery can be monitored using either activated partial thromboplastin time (aPTT) or anti-factor Xa activity (anti-Xa). However, correlation of bleeding with either of these laboratory values has not been established. We sought to determine the correlation between bleeding events and aPTT and anti-Xa in patients who undergo anticoagulation after congenital heart surgery.
      Methods: We prospectively studied pediatric patients treated with UFH after cardiac surgery over an 11-month period. Bleeding events were prospectively assessed and adjudicated. The highest aPTT and corresponding anti-Xa for the 24 hours before bleeding events were collected to assess for association with bleeding. Statistical analysis was performed using generalized additive logistic regression.
      Results: A total of 202 patients received UFH over 1488 patient-days. The median age at surgery was 0.4 years (interquartile range, 0.1-2.2). A total of 45 major or clinically relevant bleeding events were observed. The correlation between aPTT and anti-Xa was of moderate strength (R = 0.58; P < .001). The odds of bleeding increased significantly when aPTT exceeded 150 (odds ratio, 1.71 per 10-second increase in aPTT, 95% confidence interval, 1.21-2.42; P = .003). Anti-Xa was not associated with bleeding (odds ratio, 1.11 per 0.1 IU/mL increase, 95% confidence interval, 0.89-1.29; P = .34).
      Conclusions: In heparinized pediatric patients after cardiac surgery, increased risk of bleeding is more closely associated with elevated aPTT levels than elevated anti-Xa levels. In addition to anti-Xa, monitoring of aPTT levels should be considered during titration of UFH in pediatric patients after cardiac surgery.
      (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: J Thorac Cardiovasc Surg. 2018 Jul;156(1):341-342. (PMID: 29653753)
    • Contributed Indexing:
      Keywords: anticoagulation; bleeding; congenital heart disease; heparin; thrombosis
    • Accession Number:
      0 (Anticoagulants)
      0 (Biomarkers)
      9005-49-6 (Heparin)
      EC 3.4.21.6 (Factor Xa)
    • Publication Date:
      Date Created: 20180501 Date Completed: 20190923 Latest Revision: 20191210
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.jtcvs.2018.02.101
    • Accession Number:
      29709361