Document Detail


Monitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery.
MedLine Citation:
PMID:  19714446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Determine the effect of age and congenital heart disease (CHD) on whole blood tests for monitoring unfractionated heparin (UFH) in children. Determine correlation with anti-Xa levels in children undergoing cardiac catheterization or cardiac surgery. A prospective cross-sectional study of 211 healthy children about to have minor surgery (median age 3.5 years) and 110 CHD patients (median age 2.1 years) undergoing cardiac catheterization or cardiac surgery. Commonly used whole blood tests (two activated clotting times and an activated partial thromboplastin time; ACT+, ACT-LR, and APTT, respectively) were obtained before procedures and after UFH in CHD patients. Data were analyzed for effect of age and CHD and correlation with anti-Xa levels. In healthy subjects the ACT+ was lower in younger (<3 years) patients while the ACT-LR and APTT were unaffected. CHD patients exhibited an opposite trend with higher values in the younger patients. After bolus heparin the ACT+ exhibited the strongest correlation (r = 0.89) with anti-Xa levels in both locations (the APTT was too sensitive at post-bolus levels). When anti-Xa levels were below 1.0 IU/ml (range of thromboembolism therapy 0.35-0.7 IU/ml), the APTT correlation coefficient was 0.72. Some whole blood coagulation tests are affected by age in healthy children similar to laboratory tests and are variably influenced by the presence of CHD. ACT+ is the most reliable predictor of anti-Xa levels in both catheterization and surgery for pediatric patients. The APTT exhibited stronger correlation with anti-Xa than previous reports of laboratory APTT and warrants further evaluation for monitoring heparin thromboembolism therapy.
Authors:
G G Kim; S El Rouby; J Thompson; A Gupta; J Williams; D R Jobes
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  29     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  429-36     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age Factors
Anticoagulants / administration & dosage,  pharmacokinetics*
Blood Coagulation Factor Inhibitors / blood
Cardiac Surgical Procedures
Child
Child, Preschool
Cross-Sectional Studies
Factor Xa / antagonists & inhibitors
Female
Heart Catheterization*
Heart Defects, Congenital / blood,  therapy*
Heparin / administration & dosage,  pharmacokinetics*
Humans
Infant
Infant, Newborn
Male
Monitoring, Physiologic*
Partial Thromboplastin Time
Prospective Studies
Thromboembolism / blood,  drug therapy
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Blood Coagulation Factor Inhibitors; 9005-49-6/Heparin; EC 3.4.21.6/Factor Xa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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