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Epidemiology of anticoagulation for children supported by extracorporeal membrane oxygenation in the United States: A Pediatric Hospital Information System database study.
Nellis, Marianne E; An, Anjile; Mahmood, Hera; Prishtina, Fisnik; Hena, Zachary; Karam, Oliver.
Afiliação
  • Nellis ME; Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell, New York, NY, USA.
  • An A; Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
  • Mahmood H; Department of Pediatrics, New York Presbyterian Hospital-Weill Cornell, New York, NY, USA.
  • Prishtina F; Morgan Stanley Children's Hospital Administration, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
  • Hena Z; Department of Pediatrics, NYU Hassenfeld Children's Hospital, New York, NY, USA.
  • Karam O; Pediatric Critical Care Medicine, Yale School of Medicine, New Haven, CT, USA.
Perfusion ; 39(3): 536-542, 2024 Apr.
Article em En | MEDLINE | ID: mdl-36606508
INTRODUCTION: Due to the risk of thrombosis, nearly all children supported by extracorporeal membrane oxygenation (ECMO) receive systemic anticoagulation. While heparin has traditionally been used, there are reports of increased use of direct thrombin inhibitors. We sought to describe the use of anticoagulation in children supported by ECMO in the United States using a large administrative database. METHODS: We performed a retrospective cohort study of children supported by ECMO within the Pediatric Health Information System (PHIS) database. Pediatric encounters involving ECMO from 2012 to 2020 were identified. Data regarding demographics, diagnoses, anticoagulation, complications, and outcomes were extracted for eligible encounters. RESULTS: Eleven thousand five hundred ninety-five encounters that involved ECMO were identified. Fifty-four percent were male with an age range of 0-17 years and a median (IQR) age of 0 (0-2) years. Unfractionated heparin (UFH) only was used in 94% (95% CI: 93.6-94.5%) of encounters and UFH followed by bivalirudin in 5% (95% CI: 4.3-5.1%) of cases. There was a significant difference in the use of bivalirudin from 2012 to 2020 (p < 0.001). Differences in anticoagulation regimens were observed between infants and children (p = 0.004) and between those with and without cardiac indications for ECMO (p < 0.001). Four percent (95% CI: 4.1-4.8%) of encounters were associated with diagnostic coding for thrombosis and differences in occurrence of thrombosis were observed between different anticoagulant regimens (p < 0.001). CONCLUSIONS: Though the majority of children on ECMO in the United States receive heparin anticoagulation, there is an increase in use of direct thrombin inhibitors. Prospective studies must evaluate the efficacy of different anticoagulants in this patient population.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombose / Oxigenação por Membrana Extracorpórea / Sistemas de Informação Hospitalar Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombose / Oxigenação por Membrana Extracorpórea / Sistemas de Informação Hospitalar Idioma: En Ano de publicação: 2024 Tipo de documento: Article