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Unfractionated Heparin Dosing in Young Infants: Clinical Outcomes in a Cohort Monitored by Anti-Xa Levels.
MedLine Citation:
PMID:  22244010     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Unfractionated heparin (UFH) is a widely used anticoagulant. Current American College of Chest Physicians guidelines for infants extrapolated from adults recommends 28U/kg/hr of UFH to achieve an anti-Xa level of 0.35-0.7 IU/ml. Objective: We assessed the profile of anti-Xa-based UFH dosing guidelines in infants. Patients/Methods: We included all infants <6 months treated with per-protocol intravenous UFH at the Hospital for Sick Children, Toronto, over a 3.5-yr period. Results: Of 100 infants, 11% achieved sustained therapeutic anti-Xa levels utilizing current dose recommendations. Only 15% achieved target anti-Xa levels within 24 hours with per-protocol dose escalations. Seventeen percent of patients never achieved therapeutic anti-Xa levels despite up to 60 days of therapy and triple the recommended dose. Median dose to achieve therapeutic anti-Xa levels in the remaining 83 infants was 33U/kg/hour (IQR: 30-36). Two in three infants had decreased thrombus size at completion of therapy, no thrombus progression/recurrence, and 11/100 infants suffered major bleeding. Without excluding ECMO patients, an aPTT>180 seconds was detected as a risk factor for major bleeding. Conclusions: UFH monitoring is challenging in infants. Despite their delay in reaching therapeutic anti-Xa levels, infants monitored by adult-based anti-Xa range have a high thrombus resolution rate, no thrombus progression, but a relatively high bleeding rate. Extreme aPTT elevation may contribute to such bleeding risk, particularly in critically ill patients. Current UFH guidelines for young infants may still be inadequate, and laboratory methods with age-appropriate ranges may be required to further improve clinical outcomes within this population.
Authors:
T Schechter; Y Finkelstein; M Ali; W Kahr; S Williams; A K Chan; G Deveber; L R Brandão
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-13
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 International Society on Thrombosis and Haemostasis.
Affiliation:
Divisions of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, ON, Canada Clinical Pharmacology Research Program, Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
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