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The effect of heparin in arterial catheters on the coagulation in preterm infants
R A Van Lingen1, W J Hofhuis, I Dekker
1Department of Pediatrics, Erasmus University, The Netherlands.
Insights
Low-dose heparin infusions for preterm infants did not affect overall coagulation. Heparin did not alter heparin-independent clotting factors in venous or arterial samples.
Area of Science:
- Neonatal Medicine
- Pediatric Coagulation
- Critical Care Pediatrics
Background:
- Maintaining radial artery catheter patency is crucial for monitoring ventilated preterm infants.
- Heparin is often used to prevent catheter-related thrombosis.
- The impact of low-dose heparin on neonatal coagulation requires careful evaluation.
Purpose of the Study:
- To assess the effect of a continuous low-dose heparin infusion on coagulation parameters in ventilated preterm infants.
- To compare coagulation factors in venous and arterial samples from infants receiving heparin.
- To determine if heparin influences heparin-dependent and independent coagulation factors.
Main Methods:
- A comparative study involving 16 healthy preterm infants (control) and 15 ventilated preterm infants receiving intra-arterial heparin.
- Coagulation tests including activated partial thromboplastin time (APTT), thrombin time, and heparin-independent factors (AT-III, Factors I, II, V, VII) were performed on venous and arterial samples.
- Heparin concentration was measured in arterial samples.
Main Results:
- No significant differences in heparin-dependent or independent coagulation factors were observed between the venous samples of control and study groups.
- Arterial samples from infants receiving heparin showed significantly elevated APTT and thrombin times compared to venous samples, particularly at heparin levels >0.1 IU/ml.
- Heparin-independent factors remained unchanged between venous and arterial samples within the same patient.
Conclusions:
- A continuous infusion of 5 IU/ml heparin at 0.5 ml/hr intra-arterially does not significantly affect the overall coagulation status in preterm infants.
- Heparin primarily influences heparin-dependent coagulation tests (APTT, thrombin time) in arterial samples due to the heparinized catheter line.
- Heparin-independent coagulation factors can be reliably measured in both venous and arterial samples, but heparin's presence must be considered when interpreting heparin-dependent tests from arterial lines.
Abstract:
The coagulation of 16 healthy preterm infants (control infants) was compared with 15 ventilated preterm infants (study infants) receiving 0.5 ml/hr of a solution containing 5 IU/ml heparin intra-arterially in order to keep a radial artery catheter patent. A venous sample was obtained in both groups, in the study group a sample from the arterial catheter was also taken. Both the heparin dependent (APTT, thrombin time) and the heparin independent coagulation factors (AT-III, Clotting Factors I, II, V and VII) were not different between the venous samples of both groups. The arterial samples showed a significantly elevated APTT and thrombin time compared with venous samples, especially when the heparin level in the sample was higher than 0.1 IU/ml. These elevations are due to heparin in the sample from the arterial line as the venous sample in the same patient did not show any heparin effect. The heparin non-dependent factors were not different between venous and arterial samples. We conclude that a solution containing 5 IU/ml heparin given at a rate of 0.5 ml/hr does not influence coagulation in preterm infants. Determination of heparin independent coagulation factors can be done in both venous samples and samples taken from the arterial catheter, in these arterial samples the heparin dependent factors can be influenced by the heparin present in the catheters.