PMID- 26239090
OWN - NLM
STAT- MEDLINE
DCOM- 20160208
LR  - 20210202
IS  - 1528-0020 (Electronic)
IS  - 0006-4971 (Linking)
VI  - 126
IP  - 18
DP  - 2015 Oct 29
TI  - Monitoring unfractionated heparin in children: a parallel-cohort randomized 
      controlled trial comparing 2 dose protocols.
PG  - 2091-7
LID - 10.1182/blood-2015-06-651661 [doi]
AB  - Monitoring unfractionated heparin (UFH) is crucial to prevent over- or 
      under-anticoagulation. However, the optimal parameters for monitoring UFH in 
      children are not well established. The study objectives were to investigate (1) 
      the relationship between UFH dose and its anticoagulant effect as assessed by 
      anti-Xa, activated partial thromboplastin time (aPTT) and activated clotting time 
      (ACT); (2) other factors influencing UFH effect; (3) the agreement between the 
      assays; and (4) the association between UFH effect and clinical outcome. HEARTCAT 
      was a parallel-cohort randomized controlled trial comparing high-dose (100 U/kg 
      bolus followed by age-based continuous infusion in randomized children) vs 
      low-dose UFH (50 U/kg bolus) during cardiac catheterization in children. Blood 
      samples were drawn before and after UFH administration at 30, 60, and 90 minutes. 
      Four-hundred and two samples of 149 patients were evaluable. Anti-Xa, aPTT, and 
      ACT all showed good discrimination between UFH doses. Regression models 
      demonstrated the following determinants of UFH effect: UFH dose, age, baseline 
      antithrombin (for anti-Xa), and baseline levels of aPTT and ACT, respectively. 
      UFH effects were lower in infants compared with older children, which was more 
      pronounced at low-dose than at high-dose UFH. Agreement between the 3 assays was 
      poor. Most aPTT values were above therapeutic range or beyond measuring limit and 
      thus of limited value for UFH monitoring. No association of UFH dose or effect 
      with clinical outcome could be observed. In conclusion, all assays reflected a 
      significant UFH dose-effect relationship, however, with poor agreement between 
      the respective tests. The age-dependency of UFH effect was confirmed. Notably, 
      the influence of age on UFH effect was dose-dependent.
CI  - (c) 2015 by The American Society of Hematology.
FAU - Hanslik, Andreas
AU  - Hanslik A
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Kitzmuller, Erwin
AU  - Kitzmuller E
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Tran, Ulrich S
AU  - Tran US
AD  - School of Psychology, University of Vienna, Austria; and.
FAU - Thom, Katharina
AU  - Thom K
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Karapetian, Hratsch
AU  - Karapetian H
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Prutsch, Nicole
AU  - Prutsch N
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Voitl, Jasmin
AU  - Voitl J
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Michel-Behnke, Ina
AU  - Michel-Behnke I
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
FAU - Newall, Fiona
AU  - Newall F
AD  - Nursing Research, Royal Children's Hospital, Melbourne, Australia.
FAU - Male, Christoph
AU  - Male C
AD  - Division of Pediatric Cardiology, Department of Pediatrics and Adolescent 
      Medicine, Medical University of Vienna, Austria;
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20150803
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Blood. 2015 Oct 29;126(18):2075-6. PMID: 26516213
MH  - Adolescent
MH  - Age Factors
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Tests
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Double-Blind Method
MH  - *Drug Monitoring
MH  - Female
MH  - Heparin/administration & dosage/*therapeutic use
MH  - Humans
MH  - Infant
MH  - Male
MH  - Partial Thromboplastin Time
EDAT- 2015/08/05 06:00
MHDA- 2016/02/09 06:00
CRDT- 2015/08/05 06:00
PHST- 2015/06/16 00:00 [received]
PHST- 2015/07/30 00:00 [accepted]
PHST- 2015/08/05 06:00 [entrez]
PHST- 2015/08/05 06:00 [pubmed]
PHST- 2016/02/09 06:00 [medline]
AID - S0006-4971(20)30776-X [pii]
AID - 10.1182/blood-2015-06-651661 [doi]
PST - ppublish
SO  - Blood. 2015 Oct 29;126(18):2091-7. doi: 10.1182/blood-2015-06-651661. Epub 2015 
      Aug 3.