Abstract
BACKGROUND: We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO).
METHODS: We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3.
RESULTS: Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups.
CONCLUSIONS: Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected.
LEVEL OF EVIDENCE: Level III.
| Original language | English (US) |
|---|---|
| Journal | Journal of Pediatric Surgery |
| DOIs | |
| State | Published - Oct 30 2016 |
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Keywords
- Antithrombin III
- Bleeding
- Coagulation
- ECMO
- Neonatal
- Thrombosis
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Surgery
Cite this
Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation. / Stansfield, Brian K.; Wise, Linda; Ham, P. Benson; Patel, Pinkal; Parman, Malinda; Jin, Chan; Mathur, Sunil; Harshfield, Gregory; Bhatia, Jatinder.
In: Journal of Pediatric Surgery, 30.10.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation
AU - Stansfield, Brian K.
AU - Wise, Linda
AU - Ham, P. Benson
AU - Patel, Pinkal
AU - Parman, Malinda
AU - Jin, Chan
AU - Mathur, Sunil
AU - Harshfield, Gregory
AU - Bhatia, Jatinder
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/10/30
Y1 - 2016/10/30
N2 - BACKGROUND: We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO).METHODS: We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3.RESULTS: Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups.CONCLUSIONS: Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected.LEVEL OF EVIDENCE: Level III.
AB - BACKGROUND: We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO).METHODS: We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3.RESULTS: Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups.CONCLUSIONS: Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected.LEVEL OF EVIDENCE: Level III.
KW - Antithrombin III
KW - Bleeding
KW - Coagulation
KW - ECMO
KW - Neonatal
KW - Thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85006823509&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006823509&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2016.10.047
DO - 10.1016/j.jpedsurg.2016.10.047
M3 - Article
C2 - 27847121
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
ER -