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A clinical audit of antithrombin concentrate use in a tertiary paediatric centre
Christina Kozul1, Fiona Newall, Paul Monagle
1Haematology Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC 3052, Australia.
Insights
Clinical use of antithrombin concentrate (ATC) in children shows varied dosing and indications, primarily for unfractionated heparin (UFH) resistance. Further research is needed for pediatric-specific guidelines on ATC administration.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Hematology
Background:
- Antithrombin concentrate (ATC) is used in pediatric patients, but its clinical application, dosing, and indications require further investigation.
- Current practices for ATC administration in children are not well-defined, necessitating a review of existing protocols.
Purpose of the Study:
- To investigate the clinical use of antithrombin concentrate (ATC) in pediatric patients.
- To determine current practices regarding ATC administration, including specific dosing strategies and indications for use in children.
Main Methods:
- A clinical audit was conducted to review patient data from two distinct 12-month periods (1999-2000 and 2009-2010).
- The audit focused on patients treated with ATC, analyzing demographic data, dosage, and reasons for administration.
Main Results:
- Thirty-seven pediatric patients received ATC, with a median age of 30 days. The majority (90%) were in intensive care units.
- The primary indication for ATC was unfractionated heparin (UFH) resistance (76%). Post-administration, only 32% of doses achieved target antithrombin levels.
- Among patients receiving ATC to optimize UFH therapy, 28% had their UFH dose reduced without UFH effect monitoring.
Conclusions:
- Current data on antithrombin concentrate (ATC) use in children highlights variability in administration and suboptimal achievement of therapeutic levels.
- The findings underscore the need for further research into the biochemical effects of ATC and the development of evidence-based, pediatric-specific guidelines for its use.
Aim:
The aim of this study was to investigate the clinical use of antithrombin concentrate (ATC) in children and specifically to determine the current practice of ATC administration, including dosing and indications for administration.
Methods:
A clinical audit was performed of patients treated with ATC during two 12-month periods: 1 June 1999-1 June 2000 and 1 June 2009-1 June 2010.
Results:
Thirty-seven patients whose age ranged from 1 day to 13.5 years (median 30 days) received a median of two doses (range 1-15) with a median dose of 40 units/kg (range 1-200 units). The majority (90%) of patients were located in the intensive care unit, and the major indication (76%) for use of the ATC was in the setting of unfractionated heparin (UFH) resistance. Post-ATC administration, 32% of the doses given resulted in antithrombin levels reaching age-specific normative levels. Of the patients administered ATC with the aim of optimising UFH therapy, 28% of patients had their UFH dose reduced without any measurement of UFH effect.
Conclusions:
This data provides the basis for future investigations of the specific biochemical changes accompanying ATC administration and the development of paediatric-specific evidence-based guidelines for ATC use.
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