Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort

Saini, Surbhi; Folta, Ashley N.; Harsh, Katherine L; Stanek, Joseph; Dunn, Amy L.; O’Brien, Sarah H.; Kumar, Riten

doi:10.1016/j.jpeds.2019.02.015

Cited by 12 publications

(26 citation statements)

References 39 publications

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“…Over the course of the study, 173 patients received therapeutic doses of UFH at NCH. Ninety‐five patients (35 females) met inclusion criteria and were included in the original analysis 6 . Median (range) age was 8 years (birth‐20) and median weight at the time of anticoagulation initiation was 28.6 kg (1.65‐131.3).…”

Section: Resultsmentioning

confidence: 99%

“…Details of the study cohort have been previously described 6 . In summary, all pediatric patients under <21 years of age who received UFH infusion (target anti‐FXa goal: 0.35‐0.7 units/mL) over a 20‐month period at Nationwide Children's Hospital (NCH) were included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Infusion rates were titrated to maintain an anti‐FXa level of 0.35‐0.7 units/mL, using an institutional nomogram (Table 1). 6 The anti‐FXa assay was performed using the commercially available STA‐R Evolution Analyzer (Diagnostica Stago Inc, Parsippany, NJ) using the STA‐liquid anti‐FXa reagent.…”

Section: Methodsmentioning

confidence: 99%

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Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Kuhn

Saini

Stanek

et al. 2021

Pediatric Blood & Cancer

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To evaluate the correlation between an uncapped, actual body weight-based unfractionated heparin dosing strategy, we performed a body mass index-based subanalysis of a previously reported pediatric cohort. Nearly half (45%) of obese patients were supra-therapeutic on initial anti-FXa assessment. Obese patients achieved therapeutic anti-FXa significantly faster than nonobese patients (median 4 vs 12 hours, P = .0192) and were more likely to have any supra-therapeutic anti-FXa levels (77% vs 35%; P = .0021). There was no statistically significant difference in major or clinically relevant nonmajor bleeding rates between weight categories (P = .69). Prospective pediatric studies are warranted to confirm our findings.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Kuhn

Saini

Stanek

et al. 2021

Pediatric Blood & Cancer

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“…Alteplase dose used for CDT was 0.03 mg/kg/h (maximum dose 2 mg/h) . All patients received fixed‐dose unfractionated heparin at 10 units/kg/h during alteplase infusion …”

Section: Methodsmentioning

confidence: 99%

“…18 All patients received fixed-dose unfractionated heparin at 10 units/kg/h during alteplase infusion. 19 Post-lysis pulmonary arteriograms were performed for all patients, and thrombolysis was terminated if reduction of sufficient thrombus burden to allow restoration of antegrade venous flow was seen ( Figure 1). Thrombolysis was well tolerated in the patient cohort with no patient developing major/clinically relevant non-major bleeding.…”

Section: Thrombolysismentioning

confidence: 99%

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

Belsky

Warren

Stanek

et al. 2019

Pediatric Blood & Cancer

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Incidence of venous thromboembolism, including pulmonary embolism (PE), continues to rise in children. Optimum management of submassive PE is unclear. The principal objective of this retrospective study was to investigate the radiological and clinical outcomes in children with submassive PE treated with catheter‐directed thrombolysis (CDT). Five patients underwent six episodes of CDT. No patient developed major/clinically relevant non‐major bleeding. Most patients had complete radiological thrombus resolution and no patient had evidence of chronic thromboembolic pulmonary hypertension. There is an urgent need for larger prospective cohort studies/randomized controlled trials to investigate the role of CDT in pediatric PE.

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Reassessing the Pediatric Dosing Recommendations for Unfractionated Heparin Using Real‐World Data: A Pharmacokinetic–Pharmacodynamic Modeling Approach

Salem

Niu

Li³

et al. 2022

The Journal of Clinical Pharma

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Optimal pediatric dosing of unfractionated heparin (UFH) is challenging because of the paucity of clinical outcome and pharmacokineticpharmacodynamic (PK/PD) studies in pediatrics. This study aimed to: (i) develop a PK/PD model for UFH, quantified by anti-factor Xa assay, and the UFH effect, measured by activated partial thromboplastin time (aPTT); and (ii) use simulations to evaluate pediatric UFH infusions for achieving the anti-factor Xa (0.3-0.7 IU/mL) therapeutic target. Electronic health record data were retrospectively collected from 633 patients aged <19 years admitted to Texas Children's Hospital. The PK/PD model was developed using a 70% (training)/30% (testing) split-sample approach. A 1-compartment PK model with linear elimination adequately described the UFH PK. An allometrically scaled body weight on clearance (CL) and volume of distribution (Vd) with an age-dependent maturation function of extracellular water on Vd were the covariates identified. Comparable with literature, the typical values for CL and Vd were 3.28 L/(h•50 kg) and 8.83 L/50 kg, respectively. A linear model adequately described the UFH-aPTT relationship with an estimated slope of 150 seconds/(IU/mL). Simulations of the currently recommended starting infusions (28 IU/h/kg for pediatrics <1 year old or 20 IU/h/kg for pediatrics >1 year old) showed that the anti-factor Xa therapeutic target was achieved only in 15.3%, 14.6%, 36.9%, and 45.11% of subjects in the age groups of <1 year, 1-6 years, 6-12 years, and 12-19 years, respectively. In conclusion, the UFH anti-factor Xa target is not achieved initially, especially in young pediatrics, suggesting the need to optimize UFH dosing to achieve higher therapeutic success.

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Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort

Cited by 12 publications

References 39 publications

Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

Reassessing the Pediatric Dosing Recommendations for Unfractionated Heparin Using Real‐World Data: A Pharmacokinetic–Pharmacodynamic Modeling Approach

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