PMID- 29709361
OWN - NLM
STAT- MEDLINE
DCOM- 20190923
LR  - 20191210
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 156
IP  - 1
DP  - 2018 Jul
TI  - Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in 
      heparinized pediatric patients after cardiac surgery.
PG  - 332-340.e1
LID - S0022-5223(18)30892-4 [pii]
LID - 10.1016/j.jtcvs.2018.02.101 [doi]
AB  - OBJECTIVES: Anticoagulation with unfractionated heparin (UFH) after pediatric 
      cardiac surgery can be monitored using either activated partial thromboplastin 
      time (aPTT) or anti-factor Xa activity (anti-Xa). However, correlation of 
      bleeding with either of these laboratory values has not been established. We 
      sought to determine the correlation between bleeding events and aPTT and anti-Xa 
      in patients who undergo anticoagulation after congenital heart surgery. METHODS: 
      We prospectively studied pediatric patients treated with UFH after cardiac 
      surgery over an 11-month period. Bleeding events were prospectively assessed and 
      adjudicated. The highest aPTT and corresponding anti-Xa for the 24 hours before 
      bleeding events were collected to assess for association with bleeding. 
      Statistical analysis was performed using generalized additive logistic 
      regression. RESULTS: A total of 202 patients received UFH over 1488 patient-days. 
      The median age at surgery was 0.4 years (interquartile range, 0.1-2.2). A total 
      of 45 major or clinically relevant bleeding events were observed. The correlation 
      between aPTT and anti-Xa was of moderate strength (R = 0.58; P < .001). The odds 
      of bleeding increased significantly when aPTT exceeded 150 (odds ratio, 1.71 per 
      10-second increase in aPTT, 95% confidence interval, 1.21-2.42; P = .003). 
      Anti-Xa was not associated with bleeding (odds ratio, 1.11 per 0.1 IU/mL 
      increase, 95% confidence interval, 0.89-1.29; P = .34). CONCLUSIONS: In 
      heparinized pediatric patients after cardiac surgery, increased risk of bleeding 
      is more closely associated with elevated aPTT levels than elevated anti-Xa 
      levels. In addition to anti-Xa, monitoring of aPTT levels should be considered 
      during titration of UFH in pediatric patients after cardiac surgery.
CI  - Copyright (c) 2018 The American Association for Thoracic Surgery. Published by 
      Elsevier Inc. All rights reserved.
FAU - Oladunjoye, Olubunmi O
AU  - Oladunjoye OO
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
FAU - Sleeper, Lynn A
AU  - Sleeper LA
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Mass.
FAU - Nair, Asha G
AU  - Nair AG
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Mass.
FAU - Trenor, Cameron C 3rd
AU  - Trenor CC 3rd
AD  - Division of Hematology/Oncology, Boston Children's Hospital, Boston, Mass.
FAU - VanderPluym, Christina
AU  - VanderPluym C
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Mass.
FAU - Kheir, John N
AU  - Kheir JN
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Mass.
FAU - Emani, Sitaram M
AU  - Emani SM
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass. 
      Electronic address: Sitaram.Emani@cardio.chboston.org.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Webcast
DEP - 20180404
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
RN  - 0 (Anticoagulants)
RN  - 0 (Biomarkers)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2018 Jul;156(1):341-342. PMID: 29653753
MH  - Age Factors
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Biomarkers/blood
MH  - Blood Coagulation/*drug effects
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Child, Preschool
MH  - Drug Monitoring/*methods
MH  - Factor Xa/*metabolism
MH  - Heart Defects, Congenital/*surgery
MH  - Heparin/administration & dosage/*adverse effects
MH  - Humans
MH  - Infant
MH  - *Partial Thromboplastin Time
MH  - Postoperative Hemorrhage/blood/chemically induced/*diagnosis
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Thrombosis/blood/diagnosis/etiology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - anticoagulation
OT  - bleeding
OT  - congenital heart disease
OT  - heparin
OT  - thrombosis
EDAT- 2018/05/02 06:00
MHDA- 2019/09/24 06:00
CRDT- 2018/05/01 06:00
PHST- 2017/05/01 00:00 [received]
PHST- 2017/11/30 00:00 [revised]
PHST- 2018/02/11 00:00 [accepted]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2019/09/24 06:00 [medline]
PHST- 2018/05/01 06:00 [entrez]
AID - S0022-5223(18)30892-4 [pii]
AID - 10.1016/j.jtcvs.2018.02.101 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2018 Jul;156(1):332-340.e1. doi: 
      10.1016/j.jtcvs.2018.02.101. Epub 2018 Apr 4.