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Updated: May 16, 2026

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Risk Factor Analysis of Inadequate Heparin Response in Pediatric Cardiac Surgery.

Sirintip Swangwong1, Kirsten Odegard2, Gregory Matte3

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Journal of Cardiothoracic and Vascular Anesthesia
|May 14, 2026
PubMed
Summary
This summary is machine-generated.

Inadequate heparin response is common in pediatric cardiac surgery. Age-specific risk scores using routine labs can help stratify risk and tailor anticoagulation in neonates and children.

Keywords:
Cardiopulmonary bypassCongenital heart diseaseHeparin ResponseNeonatal coagulationPediatric cardiac surgeryRisk assessment score

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Area of Science:

  • Pediatric Cardiology
  • Anesthesiology
  • Hematology

Background:

  • Heparin is crucial for anticoagulation during cardiopulmonary bypass in pediatric cardiac surgery.
  • Inadequate heparin response can lead to thrombotic complications.
  • Predictive models for heparin response in this population are lacking.

Purpose of the Study:

  • To identify risk factors for inadequate heparin response in pediatric patients undergoing congenital heart surgery.
  • To develop age-specific predictive scoring systems for heparin response.

Main Methods:

  • Retrospective cohort study at a tertiary medical center.
  • Analysis of 1,746 pediatric patients (<18 years) undergoing cardiac surgery with cardiopulmonary bypass.
  • Development of separate risk scores for neonates and non-neonates based on routine laboratory values.

Main Results:

  • Inadequate heparin response occurred in 12.6% of cases.
  • Non-neonatal factors: surgical urgency, high platelets, high neutrophils.
  • Neonatal factors: low hematocrit, low neutrophils, high fibrinogen.
  • Risk scores showed good discrimination (AUC 0.775 for non-neonates, 0.827 for neonates).

Conclusions:

  • Inadequate heparin response is prevalent in pediatric cardiac surgery.
  • Age-specific risk scores can be developed using routine laboratory values.
  • These scores facilitate early risk stratification and personalized anticoagulation strategies.