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Clinical use of unfractionated heparin therapy in children: time for change?

Fiona Newall1, Vera Ignjatovic, Linda Johnston

  • 1Department of Paediatrics, The University of Melbourne, Parkville, Vic., Australia. fiona.newall@rch.org.au

British Journal of Haematology
|July 16, 2010
PubMed

Insights

Pediatric unfractionated heparin (UFH) management requires new guidelines. Current adult-based recommendations, using protamine titration or anti-Xa assays, do not provide safe or effective UFH ranges in children.

Area of Science:

  • Pediatric pharmacology
  • Thrombosis and hemostasis
  • Clinical trial analysis

Background:

  • Pediatric unfractionated heparin (UFH) dosing relies on adult data, leading to suboptimal outcomes.
  • There is a lack of specific UFH concentration and effect data in pediatric populations.

Purpose of the Study:

  • To determine UFH concentration in children.
  • To correlate UFH concentration with measures of UFH effect.
  • To evaluate the appropriateness of current pediatric UFH therapeutic ranges.

Main Methods:

  • First study to measure UFH concentration in children.
  • Correlated protamine titration (concentration) with activated partial thromboplastin time (APTT), anti-Xa assay, and thrombin clotting time (effect).

Main Results:

  • Correlation coefficients found between protamine titration and APTT, anti-Xa, and thrombin clotting time were 0.59, 0.46, and 0.52, respectively.
  • A protamine titration of 0.2-0.4 iu/ml in children corresponded to an anti-Xa assay range of 0.17-0.85 iu/ml, not the 0.35-0.7 iu/ml range.
  • Using anti-Xa or protamine titration to set APTT ranges resulted in upper limits exceeding 200 s.

Conclusions:

  • Existing adult-derived UFH therapeutic ranges are not equivalent or appropriate for pediatric use.
  • Current pediatric clinical guidelines for UFH management lack sufficient evidence.
  • Urgent re-evaluation of UFH management strategies in children is necessary.

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