An anticoagulation protocol for use after congenital cardiac surgery

Abstract

The use of a standardized anticoagulation protocol is feasible and might reduce the incidence of bleeding and thrombosis events in postcardiotomy patients.

Finding the sweet spot: Titrating unfractionated heparin in children after cardiac surgery to prevent thrombosis and minimize bleeding

“…Reprinted with permission. 4 and anti-Xa, improved both compliance and reduced bleeding in this cohort. The generalizability of this protocol remains to be seen, and several issues warrant consideration: (1) This protocol was studied only in postoperative cardiac cases to prevent thrombosis and (2) coagulation assays between laboratory tests are highly variable; consequently absolute values of both PTT and anti-Xa from this single-center study may not correlate well with those in other centers.…”

“…The generalizability of this protocol remains to be seen, and several issues warrant consideration: (1) This protocol was studied only in postoperative cardiac cases to prevent thrombosis and (2) coagulation assays between laboratory tests are highly variable; consequently absolute values of both PTT and anti-Xa from this single-center study may not correlate well with those in other centers. 5 However, the authors 4 have accepted the challenge of teasing apart the clinical effect/outcomes of UFH in a complicated cohort when using different laboratory testing to determine the ''sweet spot'' of therapy: minimal bleeding with no increase in thrombosis.…”

Novel Coagulation Analyzers in Development: A Glimpse toward the Future of Microfluidics

“…Compared to adults, pediatric patients require more frequent dose adjustments to maintain therapeutic levels, and repetitive sampling over a period of weeks can lead to anemia and the need for blood transfusion. 29 Including discarded blood related to sample draw from a heparinized line, the median total blood loss related to anticoagulation testing during audit of patients undergoing heparin therapy following cardiac surgery was 79.5 mL during the 2-week period (unpublished data).…”

Commentary: Thromboprophylaxis after congenital cardiac surgery—Time for evidence-based guidelines

“…This discordance between aPTT and anti-Xa levels inspired the development of an UFH dose titration protocol that was based on both assay; this resulted in reduced clinically relevant bleeding and time spent with supratherapeutic heparin levels. 5 Vorisek and colleagues 1 are to be commended for studying outcomes associated with varying UFH doses. This highly relevant topic is of great consequence to our patients and has not been adequately addressed in the existing literature.…”