Related Experiment Video
Updated: Aug 8, 2025
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Evaluation of acquired antithrombin deficiency in paediatric patients supported on extracorporeal membrane
David E Procaccini1, Jennifer Roem2, Derek K Ng2
1Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Insights
Antithrombin (AT) deficiency is common in pediatric extracorporeal membrane oxygenation (ECMO) patients. Protocols focusing on heparin resistance reduce AT administrations without impacting patient outcomes, but optimal dosing requires further study.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Extracorporeal life support
Background:
- Antithrombin (AT) monitoring and dosing in pediatric extracorporeal membrane oxygenation (ECMO) lacks established best practices.
- AT deficiency is a significant concern in pediatric ECMO patients, potentially impacting anticoagulation and outcomes.
Purpose of the Study:
- To investigate antithrombin (AT) monitoring, dosing, and dose-response in pediatric ECMO patients.
- To compare outcomes between two different AT replacement protocols.
Main Methods:
- Retrospective cohort study of pediatric ECMO patients (<18 years) from 2011-2020.
- Analysis of 201 ECMO runs and 2028 AT activity measurements.
- Comparison of AT activity, dosing, and adverse events between two clinical protocols.
Main Results:
- High prevalence of AT deficiency (43.3%) in pediatric ECMO patients.
- A protocol targeting heparin resistance led to fewer AT administrations but similar patient/circuit outcomes.
- Approximately one-third of patients remained AT deficient post-repletion.
Conclusions:
- Pediatric ECMO patients exhibit a high prevalence of antithrombin deficiency.
- An AT replacement protocol guided by heparin resistance reduces AT administrations without compromising outcomes.
- Further research is necessary to establish optimal AT dosing strategies in pediatric ECMO.
Aims:
There remains a paucity of literature regarding best practice for antithrombin (AT) monitoring, dosing and dose-response in paediatric extracorporeal membrane oxygenation (ECMO) patients.
Methods:
We conducted a retrospective cohort study at a quaternary care paediatric intensive care unit in all patients <18 years of age supported on ECMO from 1 June 2011 to 30 April 2020. Adverse events and outcomes were characterized for all ECMO runs. AT activity and replacement were characterized and compared between two clinical protocols. AT activities measured post- vs. pre-AT replacement were compared in order to characterize a dose-response relationship.
Results:
The final cohort included 191 patients with 201 ECMO runs and 2028 AT activity measurements. The median AT activity was 65% (interquartile range [IQR], 51-82) and 879 (43.3%) measurements met the criteria of deficient. The overall median AT dose and increase in AT activity were 50.6 units/kg/dose (IQR, 39.5-67.2) and 23.5% (IQR, 9.8-36.0), respectively. In the protocol that restricted AT activity measurements to clinical scenarios concerning for heparin resistance, there was significantly higher dosing in conjunction with significantly fewer overall administrations. Approximately one third of AT activity remained deficient after repletion. There was no difference in mechanical complications, reasons for discontinuation of ECMO support, time on ECMO or survival between protocols.
Conclusions:
There was a high prevalence of AT deficiency in paediatric ECMO patients. An AT replacement protocol based on evaluating heparin resistance is associated with fewer AT administrations, with similar circuit and patient outcomes. Further data are needed to identify optimal dosing strategies.
More Related Videos
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care