Supplemental Antithrombin Is Effective in Achieving Adequate Anticoagulation in Infants and Children With an Inadequate Response to Heparin.

ABSTRACT

OBJECTIVE: To demonstrate that supplemental antithrombin (AT) is effective in establishing adequate anticoagulation in infants and children with initially inadequate responses to heparin. DESIGN: Following institutional review board approval, a retrospective chart review was conducted on pediatric patients receiving AT during cardiac surgery requiring cardiopulmonary bypass. SETTING: A single institutional review in a hospital setting. PARTICIPANTS: Thirty-one pediatric patients with age ranging from 1 day to 36 months (median 12 weeks) receiving AT during the study period. INTERVENTIONS: As this was a retrospective chart review, no active interventions on patients were performed. MEASUREMENTS AND MAIN RESULTS: Data collected included patient age, sex, weight, activated clotting time (ACT) values, as well as heparin and AT doses. Primary outcomes were the increase in the ACT from pre- to post-AT and the number of patients who achieved an ACT>480 seconds. The paired t-test was used to compare pre- and post-AT ACT. Mean dose of AT was 50 U/kg (standard deviation 6). Following administration of AT, 30 pediatric patients achieved an ACT of>480 seconds. The post-AT ACT was significantly higher than the pre-AT by a mean of 327 seconds (p<0.0001); 96% of patients achieved an adequate ACT to initiate cardiopulmonary bypass. No adverse events attributable to AT were recorded. CONCLUSION: AT was effective in achieving adequate anticoagulation in a small cohort of infants and children undergoing cardiac surgery who initially were poorly responsive to heparin. Further research to examine the utility of AT in improving clinical outcomes is warranted.