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Assessment of the standard pediatric unfractionated heparin dosing protocol

Eman E Al Obary1, Abdulrazaq S Al-Jazairi, Iman M Zaghloul

  • 1Pharmacy Services, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.

Asian Cardiovascular & Thoracic Annals
|April 14, 2012
PubMed

Insights

Adhering to a weight-based nomogram for unfractionated heparin therapy in pediatric patients significantly shortens the time to reach therapeutic anticoagulation. This approach achieves target activated partial thromboplastin time faster without increasing bleeding risk.

Area of Science:

  • Pediatric Pharmacology
  • Thrombosis and Hemostasis
  • Clinical Therapeutics

Background:

  • Current unfractionated heparin dosing in pediatrics relies on a single study's weight-based nomogram.
  • Lack of comparative data on nomogram adherence for pediatric heparin therapy.

Purpose of the Study:

  • To evaluate if strict adherence to a weight-based nomogram improves unfractionated heparin therapeutic outcomes in pediatric patients.
  • To compare time to target anticoagulation and bleeding risk between nomogram-guided and non-nomogram-guided therapy.

Main Methods:

  • Prospective monitoring of 25 pediatric patients receiving weight-based nomogram-guided unfractionated heparin.
  • Comparison with a control group not following the standard nomogram.
  • Analysis of time to achieve target activated partial thromboplastin time and bleeding events.

Main Results:

  • The study group achieved target activated partial thromboplastin time significantly faster (18.32 h) than controls (43.8 h).
  • Higher proportions in the study group reached target activated partial thromboplastin time at 12, 24, and 36 hours (44% vs. 6%, 72% vs. 28%, 100% vs. 58%).
  • No increased bleeding risk observed with nomogram adherence; however, infants under 1 year required more time to reach target activated partial thromboplastin time.

Conclusions:

  • The standard weight-based nomogram is effective for early anticoagulation achievement in pediatric patients.
  • Further research is needed to optimize the nomogram for pediatric patients under 1 year of age.
  • Weight-based nomogram adherence offers safe and efficient unfractionated heparin therapy in pediatric populations.

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