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Administration of antithrombin concentrate in infants and children on extracorporeal life support improves
Lindsay M Ryerson1, Aisha K Bruce, Laurance Lequier
1From the *Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada; and †Department of Pediatrics and Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
High-dose antithrombin concentrate (ATC) effectively improves anticoagulation in pediatric patients on extracorporeal life support (ECLS) when unfractionated heparin (UFH) is insufficient. This treatment showed no acute adverse events and reduced UFH requirements.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Cardiopulmonary Support
Background:
- Extracorporeal life support (ECLS) requires unfractionated heparin (UFH) for circuit patency in pediatric patients.
- High-dose UFH can be insufficient for adequate anticoagulation in some ECLS cases.
- Antithrombin concentrate (ATC) is a potential adjunct therapy when UFH alone is inadequate.
Purpose of the Study:
- To review clinical experience with administering 1,000 units (U) of ATC to pediatric ECLS patients on UFH.
- To assess antithrombin (AT) levels pre- and post-ATC administration.
- To evaluate the efficacy and safety of high-dose ATC in this population.
Main Methods:
- Retrospective chart review of pediatric patients on ECLS who received ATC between June 2008 and May 2011.
- Analysis of 78 ATC doses administered to 36 patients.
- Measurement of antithrombin (AT) and anti-Xa levels before and after ATC administration.
Main Results:
- Mean AT level increased from 0.40 to 0.93 U/ml post-ATC administration.
- Mean anti-Xa level increased from 0.23 to 0.41 U/ml post-ATC administration.
- No acute adverse events were associated with ATC administration.
Conclusions:
- High-dose ATC administration significantly increases antithrombin levels and improves anticoagulation in pediatric ECLS patients.
- ATC is a safe and effective adjunct to UFH when anticoagulation is suboptimal.
- ATC administration may decrease unfractionated heparin dose requirements during ECLS.
Abstract:
Unfractionated heparin (UFH) is required in children on extracorporeal life support (ECLS) to maintain circuit patency. When high-dose UFH is inadequate to maintain an anticoagulant effect, the addition of antithrombin concentrate (ATC) is considered. The objective of this study was to review clinical experience giving 1,000 units (U) of ATC to patients on ECLS and UFH anticoagulation. Specifically, antithrombin (AT) levels pre- and post-administration of high-dose ATC, estimation of the efficacy of high-dose ATC administration as measured by the level of anticoagulation, and the incidence of adverse effects were determined. A retrospective chart review of all infants and children on ECLS who received ATC between June 2008 and May 2011 at Stollery Children's Hospital, Edmonton, Canada, was performed. A total of 78 doses of ATC were administered to 36 patients with a median age of 2.9 months (interquartile range, 0.6-12.6) on ECLS. Mean dose of ATC was 241 U/kg (95% confidence interval, 199-283). Mean AT level pre- and post-administration was 0.40 and 0.93 U/ml, respectively. Mean anti-Xa level pre- and post-AT administration was 0.23 and 0.41 U/ml, respectively. There were no associated acute adverse events. The administration of high-dose ATC decreases UFH dose requirements.
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