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Coagulation monitoring correlation with heparin dose in pediatric extracorporeal life support

Katie Moynihan1,2,3, Kerry Johnson1, Lahn Straney4

  • 11 Pediatric Intensive Care Unit, Lady Cilento Children's Hospital (LCCH), Brisbane, Australia.

Perfusion
|July 12, 2017
PubMed

Insights

Monitoring heparin anticoagulation during extracorporeal life support (ECLS) is challenging. Anti-Factor Xa activity (anti-Xa) and thromboelastogram (TEG®6s) showed better correlation with heparin dose but had unexplained variations, suggesting further research is needed.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Cardiovascular Surgery

Background:

  • Extracorporeal Life Support (ECLS) is associated with significant thrombotic and hemorrhagic risks.
  • Optimal anticoagulation monitoring during ECLS remains controversial, impacting patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of various coagulation tests in monitoring heparin anticoagulation in pediatric ECLS.
  • To evaluate the correlation between heparin dose and coagulation test results, including anti-Factor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), activated clotting time (ACT), and thromboelastogram (TEG®6s) parameters.

Main Methods:

  • Retrospective study of pediatric patients (<18 years) undergoing ECLS over 12 months.
  • Collected data on anti-Xa, aPTT, ACT, and TEG®6s parameters, correlating them with unfractionated heparin infusion rates.
  • Analyzed mean test results in relation to ECLS runs and the presence of thrombotic complications.

Main Results:

  • Sixty-six percent of ECLS runs experienced thrombotic complications, with 22% PICU mortality.
  • Heparin dose explained only 9.9-13.3% of the variation in anti-Xa and TEG®6s results, and less than 1% for aPTT and ACT.
  • Lower mean anti-Xa levels were observed in non-survivors and runs complicated by thrombosis.

Conclusions:

  • Anti-Xa and TEG®6s demonstrated the best correlation with heparin dose but had substantial unexplained variability.
  • Individual variations and other factors significantly influence coagulation test results, necessitating further investigation.
  • Population pharmacokinetic/pharmacodynamic modeling and prospective trials are crucial for optimizing heparin therapy in ECLS.
Abstract

Keywords:
blood coagulation testschildextracorporeal membrane oxygenationheparinintensive care unitspediatricthromboelastography

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