Document Detail


Thrombin formation and effect of unfractionated heparin during pediatric cardiac catheterization.
MedLine Citation:
PMID:  22915548     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To assess the strength of thrombin formation and determine the effects of unfractionated heparin (UFH) in children during cardiac catheterization. BACKGROUND: UFH reduces the thrombotic risk related to catheterization but the effects of UFH on the coagulation system in children, and proper monitoring of UFH remain unclear. METHODS: We studied 42 patients aged 3-12 years undergoing catheterization. Twenty-seven received UFH (group A) and 15 patients did not (group B). Anticoagulation was assessed by measurements of plasma prothrombin fragment F1+2, thrombin-antithrombin (TAT) complexes, D-dimer, activated partial thromboplastin time (APTT), anti-FXa, and prothrombinase-induced clotting time (PiCT). RESULTS: Markers of thrombin generation remained low during catheterization in group A. In group B, both F1+2 and TAT had increased significantly (p<0.05) by the end of the procedure vs. baseline and vs. respective levels in group A. In group A, 15 minutes after heparinization, APTT was over 180s (in all patients), anti-FXa 1.4 U/ml (1.1-2.4 U/ml) and PiCT 1.5 U/ml (1.3-2.4 U/ml). Anti-FXa and PiCT were correlated (R=0.84, p<0.0001). CONCLUSIONS: Thrombin generation was enhanced in patients who did not receive UFH, which may increase the risk of thrombotic complications. In group A, routine heparinization seemed excessive by all monitoring methods. UFH prevented an increase in prothrombin to thrombin conversion, resulting in unaltered fibrin formation. The current UFH protocol seemed to have no effect on post-procedural activation of coagulation. Further studies are needed to clarify adequate heparin dosing for children during cardiac catheterization to prevent thrombotic complications without predisposing the patient to bleeding complications. © 2012 Wiley Periodicals, Inc.
Authors:
Dawei Chen; Satu Långström; Jari Petäjä; Markku Heikinheimo; Jaana Pihkala
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-23
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
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