Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort

Surbhi Saini, Ashley N. Folta, Katherine L. Harsh, Joseph R. Stanek, Amy L. Dunn, Sarah H. O'Brien, Riten Kumar

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)212-219.e1
JournalJournal of Pediatrics
Volume209
DOIs
StatePublished - Jun 1 2019

Fingerprint

Factor Xa
Partial Thromboplastin Time
Heparin
Pediatrics
Nomograms
Platelet Count
Fibrinogen
Observational Studies
Cohort Studies
Therapeutics
Hemorrhage
Safety

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Saini, S., Folta, A. N., Harsh, K. L., Stanek, J. R., Dunn, A. L., O'Brien, S. H., & Kumar, R. (2019). Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort. Journal of Pediatrics, 209, 212-219.e1. https://doi.org/10.1016/j.jpeds.2019.02.015
Saini, Surbhi ; Folta, Ashley N. ; Harsh, Katherine L. ; Stanek, Joseph R. ; Dunn, Amy L. ; O'Brien, Sarah H. ; Kumar, Riten. / Anti-Factor Xa–Based Monitoring of Unfractionated Heparin : Clinical Outcomes in a Pediatric Cohort. In: Journal of Pediatrics. 2019 ; Vol. 209. pp. 212-219.e1.
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Saini, S, Folta, AN, Harsh, KL, Stanek, JR, Dunn, AL, O'Brien, SH & Kumar, R 2019, 'Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort', Journal of Pediatrics, vol. 209, pp. 212-219.e1. https://doi.org/10.1016/j.jpeds.2019.02.015

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 journalArticle

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.

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