Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in heparinized pediatric patients after cardiac surgery

Oladunjoye, Olubunmi; Sleeper, Lynn A.; Nair, Asha; Trenor, Cameron C.; VanderPluym, Christina; Kheir, John N.; Emani, Sitaram M.

doi:10.1016/j.jtcvs.2018.02.101

Cited by 17 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Based on a previous study, our center utilizes a combination of PTT and anti-Xa levels to adjust UFH dosing. 17,18 Modifications of high dose goals may reduce the risk of bleeding in patients undergoing therapy with high-dose UFH.…”

Section: Discussionmentioning

confidence: 99%

High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery

Vorisek

Sleeper

Piekarski

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

Objective: To determine the association between unfractionated heparin (UFH) dose and the rate of postoperative bleeding and thrombosis events in pediatric cardiac patients. We tested the hypothesis that high-dose UFH is associated with higher rates of bleeding and thrombosis.Methods: This is a retrospective review of pediatric patients admitted to the cardiac intensive care unit following cardiac surgery between November 2016 and December 2017. Peripheral venous thrombosis was excluded from analysis. Bleeding was defined as spontaneous bleeding remote from procedural manipulation. Postoperative UFH dosing strategy was categorized into 3 groups: no UFH, low-dose UFH (<15 U/kg/h) and high-dose UFH (!15 U/kg/h). Statistical analysis was performed using multivariable logistic regression. Results:We observed 966 consecutive patients (median age, 1.37 years; interquartile range, 0.27-5.50 years) during their stay in the cardiac intensive care unit. There were 94 patients (10%) with bleeding and 52 patients (5%) with thrombosis during follow-up. Patients receiving high-dose UFH experienced significantly more bleeding (odds ratio, 2.35; 95% confidence interval, 1.45-3.95) and thrombosis events (odds ratio, 3.65; 95% confidence interval, 1.81-7.38) compared with patients receiving low-dose UFH. The odds of bleeding (odds ratio, 0.81; 95% confidence interval, 0.45-1.47) and thrombosis (odds ratio, 0.59; 95% confidence interval, 0.26-1.35) were similar in the low-dose UFH and no-UFH groups.Conclusions: Bleeding remote from immediate postsurgical bleeding occurs uncommonly in pediatric patients following cardiac surgery. Anticoagulation with high-dose UFH is associated with higher bleeding rates as well as higher thrombosis rates. Indications for high-dose UFH should be carefully considered to reduce the rate of bleeding in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery

Vorisek

Sleeper

Piekarski

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, available studies indicated that aPTT was neither sensitive nor specific to define coagulation dysfunction. [21][22][23][24][25][26][27][28][29][30][31] The presence of DIC was also considered. However, although current definitions of DIC vary, all are ultimately based on laboratory parameters that have been included in our proposed criteria for coagulation dysfunction.…”

Section: D-dimermentioning

confidence: 99%

Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

et al. 2022

View full text Add to dashboard Cite

CONTEXT Previous criteria for coagulation dysfunction in critically ill children were based mainly on expert opinion. OBJECTIVE To evaluate current evidence regarding coagulation tests associated with adverse outcomes in children to inform criteria for coagulation dysfunction during critical illness. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 by using a combination of medical subject heading terms and text words to define concepts of coagulation dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if critically ill children with coagulation dysfunction were evaluated, if performance characteristics of assessment and/or scoring tools to screen for coagulation dysfunction were evaluated, and if outcomes related to mortality or functional status, organ-specific outcomes, or other patient-centered outcomes were assessed. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form, along with risk of bias assessment, by a task force member. RESULTS The systematic review supports the presence of at least 2 of the following criteria reflecting coagulation dysfunction in the absence of liver dysfunction: platelet count <100 000 cells per μL, international normalized ratio >1.5, fibrinogen level <150 mg/dL, and D-dimer value above 10 times the upper limit of normal, or above the assay’s upper limit of detection if this limit is below 10 times the upper limit of normal. LIMITATIONS The proposed criteria for coagulation dysfunction are limited by the available evidence and will require future validation. CONCLUSIONS Validation of the proposed criteria and identified scientific priorities will enhance our understanding of coagulation dysfunction in critically ill children.

show abstract

“…The serum anticoagulant activity can be measured by the standard plasma clotting time assays. The deviation from the normal ranges for APTT and PT suggest coagulation aberrations that may lead to bleeding disorders [23,24]. The analyses of chemical pathological parameters turned out variations in these parameters as well.…”

Section: Discussionmentioning

confidence: 98%

Hematological and demographic profile of Pakistani children with isolated ventricular septal defects (VSDs)

Sarwar

Shabana

Ehsan

et al. 2020

Egypt J Med Hum Genet

View full text Add to dashboard Cite

Background Cardiac morphogenesis is a dynamic and complex process that involves a complex interaction of many genetic and environmental factors. Ventricular septal defects (VSDs) are the commonest congenital heart defects (CHDs), accounting for ~ 40% of all cardiac malformations. In Pakistan, the prevalence of VSD is increasing (4–6 in 1000 live births). In the current study, we aimed to determine the pattern of different hematological parameters and various risk factors in VSDs in local pediatric patients. We recruited the clinically diagnosed VSD children (n = 125) from various hospitals. The diagnosis was made based on echocardiography, size, number, and exact location of the defect. Hematological parameters, chemical pathological assays, and liver function analysis were performed. The blood group distribution and various risk factors were also assessed. The statistical analysis was done using the SPSS (IBM statistics version 22) software. Results The results showed that for RBCs, 20% of patients in category of 0 to 3 months are above normal range; for WBCs, 33.3% of patients are above normal range in category of 4–5 years and 12–14 years. For hemoglobin, highest percentage of patients was observed below normal range; 30% of patients in category of 0 to 3 months, 40% of patients in category 4–9 months, 35.2% of patients in category of 10 months–3 years, and 33.3% of patients in category of 12–14 years were below normal range. For platelet count, 5.66% patients were below normal range and 16.9% were above normal range. For prothrombin time (PT) and activated partial thromboplastin time (APTT) more than 90% patients were in normal range value. Elevated ALP level and significantly lower albumin levels were observed. In age range of 13–14 years, 50% patients were below range for both calcium and serum creatinine. The prevalence of cousin marriages was 62.3%, about 60% mothers used antibiotics during pregnancy, B + ve and O + ve had the highest frequencies, and most of the patients were seen in age group of 2–35 months. Conclusion All tested parameters show divergence from normal values their predictive capabilities of VSDs. To the best of our knowledge, the present study is the first to report data on hematological parameters and demographic risk factor associated with VSDs, in the Pakistani children. This data may have implication on the characterization and diagnosis of VSDs as well as on the assessment of related risk factors.

show abstract

Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in heparinized pediatric patients after cardiac surgery

Cited by 17 publications

References 16 publications

High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery

High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery

Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Hematological and demographic profile of Pakistani children with isolated ventricular septal defects (VSDs)

Contact Info

Product

Resources

About