PMID- 20629660
OWN - NLM
STAT- MEDLINE
DCOM- 20101206
LR  - 20101105
IS  - 1365-2141 (Electronic)
IS  - 0007-1048 (Linking)
VI  - 150
IP  - 6
DP  - 2010 Sep
TI  - Clinical use of unfractionated heparin therapy in children: time for change?
PG  - 674-8
LID - 10.1111/j.1365-2141.2010.08302.x [doi]
AB  - Paediatric recommendations for unfractionated heparin (UFH) management are 
      extrapolated from adult trials, a practice that may contribute to the inferior 
      UFH-related outcomes in children compared to adults. This is the first study to 
      determine UFH concentration in a population of children and correlated UFH 
      concentration with measures of UFH effect. Correlation coefficients between 
      protamine titration (concentration) and activated partial thromboplastin time 
      (APTT), anti- activated factor X (Xa) assay and thrombin clotting time (effect) 
      were 0.59, 0.46 and 0.52 respectively. A protamine titration level of 0.2-0.4 
      iu/ml in children was not equivalent to an anti-Xa assay of 0.35-0.7 iu/ml but to 
      an anti-Xa assay 0.17-0.85 iu/ml. In addition, use of the anti-Xa or protamine 
      titration assays to establish an APTT therapeutic range resulted in upper limits 
      of APTT ranges exceeding 200 s. Existing methods for determining therapeutic 
      ranges for UFH in adult populations do not produce equivalent ranges in children. 
      As a result, paediatric clinical guidelines that state a therapeutic range for 
      UFH can be determined using a protamine titration assay of 0.2-0.4 iu/ml or an 
      anti-Xa assay of 0.35-0.7 iu/ml are not based on appropriate evidence. There is 
      an urgent need for change in our approach to the use of UFH in children.
CI  - (c) 2010 Blackwell Publishing Ltd.
FAU - Newall, Fiona
AU  - Newall F
AD  - Department of Paediatrics, The University of Melbourne, Parkville, Vic., 
      Australia. fiona.newall@rch.org.au
FAU - Ignjatovic, Vera
AU  - Ignjatovic V
FAU - Johnston, Linda
AU  - Johnston L
FAU - Summerhayes, Robyn
AU  - Summerhayes R
FAU - Lane, Geoff
AU  - Lane G
FAU - Cranswick, Noel
AU  - Cranswick N
FAU - Monagle, Paul
AU  - Monagle P
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Br J Haematol
JT  - British journal of haematology
JID - 0372544
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Adolescent
MH  - Age Factors
MH  - Anticoagulants/*administration & dosage/blood/therapeutic use
MH  - Blood Coagulation Tests/methods
MH  - Child
MH  - Child, Preschool
MH  - Drug Administration Schedule
MH  - Factor Xa/immunology
MH  - Female
MH  - Heparin/*administration & dosage/blood/therapeutic use
MH  - Humans
MH  - Infant
MH  - Male
MH  - Partial Thromboplastin Time
EDAT- 2010/07/16 06:00
MHDA- 2010/12/14 06:00
CRDT- 2010/07/16 06:00
PHST- 2010/07/16 06:00 [entrez]
PHST- 2010/07/16 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
AID - BJH8302 [pii]
AID - 10.1111/j.1365-2141.2010.08302.x [doi]
PST - ppublish
SO  - Br J Haematol. 2010 Sep;150(6):674-8. doi: 10.1111/j.1365-2141.2010.08302.x.