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Antithrombin replacement during extracorporeal membrane oxygenation. Artif Organs 2011 Nov;35(11):1024-8

Date

11/22/2011

Pubmed ID

22097980

DOI

10.1111/j.1525-1594.2011.01384.x

Scopus ID

2-s2.0-81855166260 (requires institutional sign-in at Scopus site)   95 Citations

Abstract

Heparin remains the predominant anticoagulant during extracorporeal membrane oxygenation (ECMO). Heparin acts by potentiating the anticoagulant effect of antithrombin (ATIII). Acquired ATIII deficiency, common in pediatric patients requiring ECMO, may result in ineffective anticoagulation with heparin. ATIII replacement may result in increased bleeding. Our objective is to determine ATIII's effect on anticoagulation and blood loss during ECMO. A retrospective chart review was performed of all patients at Children's Hospital of Wisconsin who received ATIII while supported on ECMO in 2009. ATIII activity levels, heparin drip rate, and activated clotting times (ACT) were compared before, 4, 8, and 24 h after ATIII administration. Chest tube output and packed red blood cell (pRBC) transfusion volume were compared from 24 h before ATIII administration to 24 h after. Twenty-eight patients received ATIII as a bolus dose during the course of 31 separate times on ECMO support. The median age of these patients was 0.3 years (range 1 day-19.5 years). ATIII activity increased significantly at 8 and 24 h after administration. No significant difference was noted in heparin drip rate, ACT levels, chest tube output, or pRBC transfusion volume. ATIII administration resulted in higher ATIII activity levels for 24 h without a significant effect on heparin dose, ACT, or measures of bleeding.

Author List

Niebler RA, Christensen M, Berens R, Wellner H, Mikhailov T, Tweddell JS

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
Theresa A. Mikhailov MD, PhD Professor in the Pediatrics department at Medical College of Wisconsin
Robert Niebler MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anticoagulants
Antithrombin III
Child
Child, Preschool
Extracorporeal Membrane Oxygenation
Hemorrhage
Heparin
Humans
Infant
Infant, Newborn
Retrospective Studies
Young Adult