Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation

Brian K. Stansfield; Linda Wise; P. Benson Ham; Pinkal Patel; Malinda Parman; Chan Jin; Sunil Mathur; Gregory Harshfield; Jatinder Bhatia

doi:10.1016/j.jpedsurg.2016.10.047

Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation

Brian K. Stansfield, Linda Wise, P. Benson Ham, Pinkal Patel, Malinda Parman, Chan Jin, Sunil Mathur, Gregory Harshfield, Jatinder Bhatia

Research output: Contribution to journal › Article

16 Scopus citations

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	https://doi.org/10.1016/j.jpedsurg.2016.10.047
State	Published - Oct 30 2016

Keywords

Antithrombin III
Bleeding
Coagulation
ECMO
Neonatal
Thrombosis

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Surgery

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Stansfield, B. K., Wise, L., Ham, P. B., Patel, P., Parman, M., Jin, C., Mathur, S., Harshfield, G., & Bhatia, J. (2016). Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2016.10.047

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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.",

keywords = "Antithrombin III, Bleeding, Coagulation, ECMO, Neonatal, Thrombosis",

author = "Stansfield, {Brian K.} and Linda Wise and Ham, {P. Benson} and Pinkal Patel and Malinda Parman and Chan Jin and Sunil Mathur and Gregory Harshfield and Jatinder Bhatia",

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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

PY - 2016/10/30

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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

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