PMID- 22915548
OWN - NLM
STAT- MEDLINE
DCOM- 20131227
LR  - 20151119
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 81
IP  - 7
DP  - 2013 Jun 1
TI  - Thrombin formation and effect of unfractionated heparin during pediatric cardiac 
      catheterization.
PG  - 1174-9
LID - 10.1002/ccd.24621 [doi]
AB  - OBJECTIVES: To assess the strength of thrombin formation and determine the 
      effects of unfractionated heparin (UFH) in children during cardiac 
      catheterization. BACKGROUND: UFH reduces the thrombotic risk related to 
      catheterization but the effects of UFH on the coagulation system in children, and 
      proper monitoring of UFH remain unclear. METHODS: We studied 42 patients aged 
      3-12 years undergoing catheterization. Twenty-seven received UFH (group A) and 15 
      patients did not (group B). Anticoagulation was assessed by measurements of 
      plasma prothrombin fragment F1 + 2, thrombin-antithrombin (TAT) complexes, 
      D-dimer, activated partial thromboplastin time (APTT), anti-FXa, and 
      prothrombinase-induced clotting time (PiCT). RESULTS: Markers of thrombin 
      generation remained low during catheterization in group A. In group B, both F1 + 
      2 and TAT had increased significantly (P < 0.05) by the end of the procedure 
      versus baseline and versus respective levels in group A. In group A, 15 min after 
      heparinization, APTT was over 180 sec (in all patients), anti-FXa 1.4 U/ml 
      (1.1-2.4 U/ml) and PiCT 1.5 U/ml (1.3-2.4 U/ml). Anti-FXa and PiCT were 
      correlated (R = 0.84, P < 0.0001). CONCLUSIONS: Thrombin generation was enhanced 
      in patients who did not receive UFH, which may increase the risk of thrombotic 
      complications. In group A, routine heparinization seemed excessive by all 
      monitoring methods. UFH prevented an increase in prothrombin to thrombin 
      conversion, resulting in unaltered fibrin formation. The current UFH protocol 
      seemed to have no effect on postprocedural activation of coagulation. Further 
      studies are needed to clarify adequate heparin dosing for children during cardiac 
      catheterization to prevent thrombotic complications without predisposing the 
      patient to bleeding complications.
CI  - Copyright (c) 2012 Wiley Periodicals, Inc.
FAU - Chen, Dawei
AU  - Chen D
AD  - Children's Hospital, University of Helsinki and Helsinki University Central 
      Hospital, Helsinki, Finland.
FAU - Langstrom, Satu
AU  - Langstrom S
FAU - Petaja, Jari
AU  - Petaja J
FAU - Heikinheimo, Markku
AU  - Heikinheimo M
FAU - Pihkala, Jaana
AU  - Pihkala J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130226
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Anticoagulants)
RN  - 0 (Biomarkers)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Fibrin Fibrinogen Degradation Products)
RN  - 0 (Peptide Fragments)
RN  - 0 (antithrombin III-protease complex)
RN  - 0 (fibrin fragment D)
RN  - 0 (prothrombin fragment 1.2)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9001-26-7 (Prothrombin)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.- (Peptide Hydrolases)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Age Factors
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Antithrombin III
MH  - Biomarkers/blood
MH  - Blood Coagulation/*drug effects
MH  - *Cardiac Catheterization/adverse effects
MH  - Child
MH  - Child, Preschool
MH  - Drug Administration Schedule
MH  - Drug Monitoring/methods
MH  - Factor Xa Inhibitors
MH  - Female
MH  - Fibrin Fibrinogen Degradation Products/metabolism
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Partial Thromboplastin Time
MH  - Peptide Fragments/blood
MH  - Peptide Hydrolases/blood
MH  - Predictive Value of Tests
MH  - Prothrombin
MH  - Risk Factors
MH  - Thrombin/*metabolism
MH  - Thrombosis/blood/etiology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2012/08/24 06:00
MHDA- 2013/12/29 06:00
CRDT- 2012/08/24 06:00
PHST- 2012/04/30 00:00 [received]
PHST- 2012/08/19 00:00 [accepted]
PHST- 2012/08/24 06:00 [entrez]
PHST- 2012/08/24 06:00 [pubmed]
PHST- 2013/12/29 06:00 [medline]
AID - 10.1002/ccd.24621 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2013 Jun 1;81(7):1174-9. doi: 10.1002/ccd.24621. Epub 
      2013 Feb 26.