Supplemental Antithrombin is Effective in Achieving Adequate Anticoagulation in Infants and Children with an Inadequate Response to Heparin

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 31; no. 3; pp. 896 - 900
• Main Authors: Lopez, M., MD, Feng, C., PhD, Vasilyeva, O., PharmD, Eaton, M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: ACT; activated clotting time; Anesthesia & Perioperative Care; Anticoagulants - administration & dosage; anticoagulation; antithrombin; Antithrombins - administration & dosage; Blood Coagulation - drug effects; Blood Coagulation - physiology; cardiopulmonary bypass; Cardiovascular Surgical Procedures - adverse effects; Cardiovascular Surgical Procedures - trends; Child, Preschool; Cohort Studies; Critical Care; Drug Therapy, Combination; heparin; Heparin - administration & dosage; Humans; Infant; Infant, Newborn; Intraoperative Care - methods; Intraoperative Care - trends; pediatrics; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Treatment Outcome; heparin; ACT; anticoagulation; pediatrics; cardiopulmonary bypass; activated clotting time; Antithrombin; antithrombin
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2016.12.001

Objective To demonstrate that supplemental antithrombin (AT) is effective in establishing adequate anticoagulation in infants and children with initially inadequate responses to heparin. Design Following IRB approval, a retrospective chart review was conducted on pediatric patients receiving AT during cardiac surgery requiring cardiopulmonary bypass. Setting A single institutional review in a hospital setting. Participants 31 pediatric patients with age ranging from 1 day to 36 months (median 12 weeks) receiving AT during the study period. Interventions As this was a retrospective chart review, no active interventions on patients were performed. Measurements and Main results Data collected included: patient age, gender, weight, activated clotting time (ACT) values, as well as heparin and AT doses. Primary outcomes were the increase in the ACT from pre- to post-AT, and the number of patients who achieved an ACT >480 sec. The paired t-test was used to compare pre- and post–AT ACT. Mean dose of AT was 50 U/kg (SD 6). Following administration of AT, 30 pediatric patients achieved an ACT >480 sec. The post-AT ACT was significantly higher than the pre-AT by a mean of 327 seconds (P < 0.0001). 96% of patients achieved an adequate ACT to initiate CPB. No adverse events attributable to AT were recorded Conclusion AT was effective in achieving adequate anticoagulation in a small cohort infants and children undergoing cardiac surgery who were initially poorly responsive to heparin. Further research to examine the utility of AT in improving clinical outcomes is warranted.