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Heparin continuous infusion for thromboprophylaxis in pediatric liver transplant recipients
Khalid W Taher1,2, Reema Alhawas2, Salma Ansary2
1Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Continuous unfractionated heparin (UFH) infusion effectively prevents thrombosis in pediatric liver transplant (PLT) recipients. This thromboprophylaxis strategy achieved target anticoagulation with low rates of thrombotic and bleeding complications.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Transplant surgery
Background:
- Vascular thrombosis is a major cause of graft loss and morbidity in pediatric liver transplant (PLT) patients.
- A standardized thromboprophylaxis protocol is lacking for PLT recipients.
- This study evaluated the effectiveness of continuous unfractionated heparin (UFH) infusion for thromboprophylaxis in PLT patients.
Purpose of the Study:
- To assess the appropriateness of continuous unfractionated heparin (UFH) infusion for thromboprophylaxis in pediatric liver transplant (PLT) patients.
- To determine the percentage of PLT recipients achieving target activated partial thromboplastin time (aPTT) levels with UFH prophylaxis.
- To evaluate secondary outcomes including time to target aPTT, dose titrations, thrombotic events, bleeding complications, and safety.
Main Methods:
- Retrospective study in a pediatric intensive care unit.
- Included patients aged 1 month to 14 years receiving prophylactic continuous UFH infusion post-PLT.
- Primary outcome: percentage of patients achieving prophylactic aPTT target levels (40-60 s); secondary outcomes: time to target, dose titrations, thrombotic/bleeding events, and safety.
Main Results:
- All 47 patients achieved prophylactic aPTT target levels, with 89.4% reaching the target within 24 hours.
- Median time to target aPTT was 4.68 hours; 63.8% achieved target without dose titration.
- Low rates of thrombotic events (4.3%) and clinically significant bleeding (14.9%) were observed, with minimal need for surgical intervention.
Conclusions:
- Continuous UFH infusion at an initial dose of 10 units/kg/hr is effective for postoperative thromboprophylaxis in PLT recipients.
- The protocol demonstrated success in achieving prophylactic anticoagulation with a favorable safety profile.
- This approach is associated with low incidences of thrombotic and bleeding complications, supporting its use in PLT patients.
Background:
Vascular thrombosis remains a significant cause of early graft loss and morbidity in pediatric liver transplant (PLT) patients. However, no standardized protocol for thromboprophylaxis exists. This study aimed to evaluate appropriateness of continuous infusion of unfractionated heparin (UFH) prophylaxis in PLT patients.
Methods:
This retrospective study was conducted in a pediatric intensive care unit. Patients between the ages of 1 month to 14 years who received prophylactic continuous UFH infusion following PLT were included. The primary outcome was to examine the percentage of patients on intravenous continuous UFH infusion achieving the prophylactic aPTT target levels (40-60 s) in PLT recipients whereas secondary outcomes were time to target, dose titrations, thrombotic events, bleeding complications and safety outcomes. Statistical analyses were performed using Stata software, version 18. For categorical variables, frequencies and percentages were used whereas continuous data was presented as median and interquartile range (IQR).
Results:
A total of 47 patients were included, with the majority constituting males (57.4%). Median heparin infusion duration was 55.93 h [38.97-79.97]. All patients achieved prophylactic aPTT target levels, with 89.4% reaching the target within 24 h. Median time to target achievement was 4.68 h [4.00-12.53]. Most patients (63.8%) achieved target prophylactic anticoagulation without dose titration whereas 6.4% required ≥3 titrations. Only 2 patients (4.3%) reported thrombotic complications including one portal vein thrombosis and one hepatic vein thrombosis. Clinically significant bleeding was reported in 7 patients (14.9%), with only one patient requiring surgical re-intervention. Hypotension was observed in 40.4% of patients. Median PICU length of stay was 4 days [3-6].
Conclusion:
Postoperative thromboprophylaxis with continuous UFH infusion at an initial dose of 10 units/kg/hr was effective in achieving prophylactic anticoagulation in most PLT recipients. The protocol was associated with low thrombotic events and bleeding complications.
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