Abstract
Objectives: To assess clinical outcomes in children treated with unfractionated heparin and monitored using an anti-factor Xa (Anti-FXa)-based nomogram. We also sought to assess the correlation between activated partial thromboplastin time (APTT)and Anti-FXa. Study design: This was a single-center, observational cohort study conducted over a 20-month period that included all pediatric patients (<21 years)who received therapeutic unfractionated heparin and were monitored using an anti–FXa-based nomogram. Results: In total, 95 patients met prespecified inclusion criteria, and 1098 pairs of APTT and Anti-FXa measurements were performed. The median unfractionated heparin dose required to reach therapeutic Anti-FXa goal was significantly greater in infants compared with older children (P <.0001). The median time to achieve therapeutic Anti-FXa was 10 hours (range 2-96 hours)and was significantly shorter in patients who received a bolus compared with those who did not (P =.03). Five (5.3%)major bleeding events were noted. Age, peak Anti-FXa, peak APTT, lowest platelet count, and fibrinogen were not predictive of major and clinically relevant nonmajor bleeds. Moderate correlation between the APTT and Anti-FXa (r = 0.75; 95% CI 0.72-0.77)assays was appreciated. Conclusions: Using an anti–FXa-based nomogram to monitor unfractionated heparin in children is feasible. Although moderate correlation was observed between the APTT and Anti-FXa assays, the APTT frequently overestimated heparin activity. Safety and efficacy of an Anti-FXa nomogram needs further validation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 212-219.e1 |
| Journal | Journal of Pediatrics |
| Volume | 209 |
| DOIs | |
| State | Published - Jun 1 2019 |
Fingerprint
All Science Journal Classification (ASJC) codes
- Pediatrics, Perinatology, and Child Health
Cite this
}
Anti-Factor Xa–Based Monitoring of Unfractionated Heparin : Clinical Outcomes in a Pediatric Cohort. / Saini, Surbhi; Folta, Ashley N.; Harsh, Katherine L.; Stanek, Joseph R.; Dunn, Amy L.; O'Brien, Sarah H.; Kumar, Riten.
In: Journal of Pediatrics, Vol. 209, 01.06.2019, p. 212-219.e1.Research output: Contribution to journal › Article
TY - JOUR
T1 - Anti-Factor Xa–Based Monitoring of Unfractionated Heparin
T2 - Clinical Outcomes in a Pediatric Cohort
AU - Saini, Surbhi
AU - Folta, Ashley N.
AU - Harsh, Katherine L.
AU - Stanek, Joseph R.
AU - Dunn, Amy L.
AU - O'Brien, Sarah H.
AU - Kumar, Riten
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objectives: To assess clinical outcomes in children treated with unfractionated heparin and monitored using an anti-factor Xa (Anti-FXa)-based nomogram. We also sought to assess the correlation between activated partial thromboplastin time (APTT)and Anti-FXa. Study design: This was a single-center, observational cohort study conducted over a 20-month period that included all pediatric patients (<21 years)who received therapeutic unfractionated heparin and were monitored using an anti–FXa-based nomogram. Results: In total, 95 patients met prespecified inclusion criteria, and 1098 pairs of APTT and Anti-FXa measurements were performed. The median unfractionated heparin dose required to reach therapeutic Anti-FXa goal was significantly greater in infants compared with older children (P <.0001). The median time to achieve therapeutic Anti-FXa was 10 hours (range 2-96 hours)and was significantly shorter in patients who received a bolus compared with those who did not (P =.03). Five (5.3%)major bleeding events were noted. Age, peak Anti-FXa, peak APTT, lowest platelet count, and fibrinogen were not predictive of major and clinically relevant nonmajor bleeds. Moderate correlation between the APTT and Anti-FXa (r = 0.75; 95% CI 0.72-0.77)assays was appreciated. Conclusions: Using an anti–FXa-based nomogram to monitor unfractionated heparin in children is feasible. Although moderate correlation was observed between the APTT and Anti-FXa assays, the APTT frequently overestimated heparin activity. Safety and efficacy of an Anti-FXa nomogram needs further validation.
AB - Objectives: To assess clinical outcomes in children treated with unfractionated heparin and monitored using an anti-factor Xa (Anti-FXa)-based nomogram. We also sought to assess the correlation between activated partial thromboplastin time (APTT)and Anti-FXa. Study design: This was a single-center, observational cohort study conducted over a 20-month period that included all pediatric patients (<21 years)who received therapeutic unfractionated heparin and were monitored using an anti–FXa-based nomogram. Results: In total, 95 patients met prespecified inclusion criteria, and 1098 pairs of APTT and Anti-FXa measurements were performed. The median unfractionated heparin dose required to reach therapeutic Anti-FXa goal was significantly greater in infants compared with older children (P <.0001). The median time to achieve therapeutic Anti-FXa was 10 hours (range 2-96 hours)and was significantly shorter in patients who received a bolus compared with those who did not (P =.03). Five (5.3%)major bleeding events were noted. Age, peak Anti-FXa, peak APTT, lowest platelet count, and fibrinogen were not predictive of major and clinically relevant nonmajor bleeds. Moderate correlation between the APTT and Anti-FXa (r = 0.75; 95% CI 0.72-0.77)assays was appreciated. Conclusions: Using an anti–FXa-based nomogram to monitor unfractionated heparin in children is feasible. Although moderate correlation was observed between the APTT and Anti-FXa assays, the APTT frequently overestimated heparin activity. Safety and efficacy of an Anti-FXa nomogram needs further validation.
UR - http://www.scopus.com/inward/record.url?scp=85063779447&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063779447&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2019.02.015
DO - 10.1016/j.jpeds.2019.02.015
M3 - Article
C2 - 30961988
AN - SCOPUS:85063779447
VL - 209
SP - 212-219.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
ER -