Anti-Factor Xa Assay Is a Superior Correlate of Heparin Dose Than Activated Partial Thromboplastin Time or Activated Clotting Time in Pediatric Extracorporeal Membrane Oxygenation*

Liveris, Anna; Bello, Ricardo; Friedmann, Patricia; Duffy, Melissa; Manwani, Deepa; Killinger, James S.; Rodriquez, Daniel; Weinstein, Samuel

doi:10.1097/pcc.0000000000000028

Cited by 121 publications

(149 citation statements)

References 20 publications

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“…This potentially reflects a significant variation in response to heparin by patient as well as by the coagulation milieu at any given time. These results differ somewhat from data that suggests good correlation between aPTT and UNFH levels in adults on extracorporeal life support (ECLS)[18] as well as a recent study in a small cohort of pediatric patients on ECLS[19]. These discrepancies may reflect variations in heparin response amongst patients due to developmental differences in hemostasis and genetic variability[20,21].…”

Section: Discussioncontrasting

confidence: 81%

Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices

Bhatia¹,

Yabrodi²,

Carroll³

et al. 2017

WJC

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AIMTo assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device (VAD).METHODSRetrospective study of pediatric patients supported with a Berlin EXCOR VAD at a single pediatric tertiary care center during a single year.RESULTSWe demonstrated associations between activated thromboplastin time (aPTT) and R-thromboelastography (R-TEG) values (rs = 0.65, P < 0.001) and between anti-Xa assay and R-TEG values (rs = 0.54, P < 0.001). The strongest correlation was seen between aPTT and anti-Xa assays (rs = 0.71, P < 0.001). There was also a statistically significant correlation between platelet counts and the maximum amplitude of TEG (rs = 0.71, P < 0.001). Importantly, there was no association between dose of unfractionated heparin and either measure of anticoagulation (aPTT, anti-Xa or R-TEG value).CONCLUSIONThis study suggests that while there is strong correlation between aPTT, anti-Xa assay and R-TEG values for patients requiring VAD support, there is a lack of relevant correlation between heparin dose and degree of effect. This raises concern as various guidelines continue to recommend using these parameters to titrate heparin therapy.

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Section: Discussioncontrasting

confidence: 81%

Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices

Bhatia¹,

Yabrodi²,

Carroll³

et al. 2017

WJC

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show abstract

“…In recent years, anti-factor Xa assay was evaluated as a possible replacement for ACT and aPTT tests. The current view is that anti factor Xa test might provide superior results in adjusting heparin doses that those given by ACT and aPTT [25,26].…”

Section: Management and Monitoring Of Anticoagulationmentioning

confidence: 99%

Anticoagulation during ECMO: The Past, Present and Future

Doymaz¹

2018

J Intensive Crit Care

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In recent years, many medical centres started to use extracorporeal membrane oxygenator (ECMO) support as the last treatment option for critically ill patients when the conventional therapy fails. There are significant improvements in ECMO management since the early days of its application. In this report, we aimed to review several aspects in this complex treatment modality. One of the main areas reviewed in this article will be the anticoagulation strategy used during ECMO support and the tests utilized for monitoring coagulation parameters. Additionally, technologies used in ECMO circuits and new advances in the field were reviewed.

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“…Proponents of the activated clotting time (ACT) argue that it provides a broad, inclusive exam of clotting time that takes into account many factors such thrombocytopenia, factor depletion, and inflammation in addition to heparin levels. 36 At our center, we primarily use ACT to guide heparin administration. Thromboelastography (TEG) uses the viscoelastic properties of the blood to look at the initiation of clotting through the dissolution.…”

Section: Management Controversiesmentioning

confidence: 99%