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Antithrombin Population Pharmacokinetics in Pediatric Ventricular Assist Device Patients

Brady S Moffett1,2, Marc Anders2, Timothy Humlicek1

  • 1Department of Pharmacy, Texas Children's Hospital, Houston, TX.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 25, 2019
PubMed

Insights

Antithrombin dosing in pediatric ventricular assist device patients should utilize fat-free mass, considering unfractionated heparin dose and baseline antithrombin levels for optimal outcomes.

Area of Science:

  • Pharmacology
  • Pediatric Critical Care
  • Biomedical Engineering

Background:

  • Pediatric patients with ventricular assist devices (VADs) require careful management of anticoagulation.
  • Antithrombin is crucial for effective anticoagulation in these high-risk patients.
  • Optimizing antithrombin dosing is essential to prevent thrombotic complications.

Purpose of the Study:

  • To describe the pharmacokinetics of antithrombin in pediatric VAD patients.
  • To establish evidence-based dosing recommendations for antithrombin in this population.
  • To identify factors influencing antithrombin levels and half-life.

Main Methods:

  • Retrospective population pharmacokinetic study.
  • Analysis of data from pediatric patients (<19 years) on VAD therapy (HeartWare or Berlin EXCOR).
  • Utilized NONMEM v.7.4 for pharmacokinetic modeling and simulation.

Main Results:

  • A total of 41 pediatric patients were included.
  • Allometric scaling of fat-free mass provided a better model fit than actual body weight.
  • Unfractionated heparin dose and baseline antithrombin activity were significant covariates influencing pharmacokinetics.

Conclusions:

  • Antithrombin dosing in pediatric VAD patients should be based on fat-free mass.
  • Consideration of unfractionated heparin dose and baseline antithrombin activity is recommended.
  • These factors are critical for optimizing antithrombin therapy in pediatric VAD recipients.
Abstract

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