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Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices

Ajay K Bhatia1, Mouhammad Yabrodi1, Mallory Carroll2

  • 1Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, United States.

World Journal of Cardiology
|October 31, 2017
PubMed

Insights

Pediatric ventricular assist device (VAD) management shows strong correlations between anticoagulation tests like activated thromboplastin time (aPTT) and anti-Xa assays. However, heparin dose did not correlate with these measures, questioning current titration guidelines.

Area of Science:

  • Pediatric Cardiology
  • Hematology
  • Biomedical Engineering

Background:

  • Ventricular assist devices (VADs) are critical for pediatric heart failure management.
  • Effective anticoagulation is vital for VAD patients to prevent thrombosis and bleeding.
  • Current anticoagulation monitoring strategies require evaluation in the context of VAD support.

Purpose of the Study:

  • To evaluate the clinical utility and inter-assay correlation of standard anticoagulation parameters in pediatric VAD recipients.
  • To assess the relationship between unfractionated heparin dosage and anticoagulation test results in this population.

Main Methods:

  • A retrospective analysis of pediatric patients supported with a Berlin EXCOR VAD.
  • Inclusion of data from a single pediatric tertiary care center over one year.
  • Assessment of activated thromboplastin time (aPTT), anti-Xa assay, and R-thromboelastography (R-TEG) values.

Main Results:

  • Significant correlations were observed between aPTT and R-TEG (rs = 0.65), anti-Xa and R-TEG (rs = 0.54), and aPTT and anti-Xa (rs = 0.71).
  • Platelet count correlated with R-TEG maximum amplitude (rs = 0.71).
  • No significant association was found between unfractionated heparin dose and any anticoagulation parameter measured.

Conclusions:

  • While aPTT, anti-Xa, and R-TEG show strong inter-assay correlation in pediatric VAD patients, heparin dosage does not reliably predict anticoagulation effect.
  • This discrepancy challenges the current practice of titrating heparin based on these parameters.
  • Further research is needed to refine anticoagulation monitoring and management strategies for pediatric VAD support.
Abstract

Keywords:
AnticoagulationBERLIN-EXCORPediatricThromboelastographyVentricular assist device

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