PMID- 31399238
OWN - NLM
STAT- MEDLINE
DCOM- 20200302
LR  - 20200302
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 158
IP  - 4
DP  - 2019 Oct
TI  - High-dose heparin is associated with higher bleeding and thrombosis rates in 
      pediatric patients following cardiac surgery.
PG  - 1199-1206
LID - S0022-5223(19)31211-5 [pii]
LID - 10.1016/j.jtcvs.2019.06.015 [doi]
AB  - OBJECTIVE: To determine the association between unfractionated heparin (UFH) dose 
      and the rate of postoperative bleeding and thrombosis events in pediatric cardiac 
      patients. We tested the hypothesis that high-dose UFH is associated with higher 
      rates of bleeding and thrombosis. METHODS: This is a retrospective review of 
      pediatric patients admitted to the cardiac intensive care unit following cardiac 
      surgery between November 2016 and December 2017. Peripheral venous thrombosis was 
      excluded from analysis. Bleeding was defined as spontaneous bleeding remote from 
      procedural manipulation. Postoperative UFH dosing strategy was categorized into 3 
      groups: no UFH, low-dose UFH (<15 U/kg/h) and high-dose UFH (>/=15 U/kg/h). 
      Statistical analysis was performed using multivariable logistic regression. 
      RESULTS: We observed 966 consecutive patients (median age, 1.37 years; 
      interquartile range, 0.27-5.50 years) during their stay in the cardiac intensive 
      care unit. There were 94 patients (10%) with bleeding and 52 patients (5%) with 
      thrombosis during follow-up. Patients receiving high-dose UFH experienced 
      significantly more bleeding (odds ratio, 2.35; 95% confidence interval, 
      1.45-3.95) and thrombosis events (odds ratio, 3.65; 95% confidence interval, 
      1.81-7.38) compared with patients receiving low-dose UFH. The odds of bleeding 
      (odds ratio, 0.81; 95% confidence interval, 0.45-1.47) and thrombosis (odds 
      ratio, 0.59; 95% confidence interval, 0.26-1.35) were similar in the low-dose UFH 
      and no-UFH groups. CONCLUSIONS: Bleeding remote from immediate postsurgical 
      bleeding occurs uncommonly in pediatric patients following cardiac surgery. 
      Anticoagulation with high-dose UFH is associated with higher bleeding rates as 
      well as higher thrombosis rates. Indications for high-dose UFH should be 
      carefully considered to reduce the rate of bleeding in this population.
CI  - Copyright (c) 2019 The American Association for Thoracic Surgery. Published by 
      Elsevier Inc. All rights reserved.
FAU - Vorisek, Carina N
AU  - Vorisek CN
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; Department of 
      Pediatrics, Harvard Medical School, Boston, Mass.
FAU - Piekarski, Breanna
AU  - Piekarski B
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
FAU - Lu, Minmin
AU  - Lu M
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Mass.
FAU - Rogers, Jenna
AU  - Rogers J
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
FAU - Oladunjoye, Olubunmi O
AU  - Oladunjoye OO
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
FAU - Emani, Sitaram M
AU  - Emani SM
AD  - Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass; 
      Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic 
      address: Sitaram.Emani@cardio.chboston.org.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Video-Audio Media
DEP - 20190615
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2019 Oct;158(4):1207-1208. PMID: 31420143
MH  - Age Factors
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Blood Coagulation/*drug effects
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Heparin/administration & dosage/*adverse effects
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Postoperative Hemorrhage/*chemically induced
MH  - Risk Assessment
MH  - Risk Factors
MH  - Thrombosis/blood/etiology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - anticoagulation
OT  - bleeding
OT  - congenital heart disease
OT  - heparin
OT  - thrombosis
EDAT- 2019/08/11 06:00
MHDA- 2020/03/03 06:00
CRDT- 2019/08/11 06:00
PHST- 2018/04/30 00:00 [received]
PHST- 2019/06/04 00:00 [revised]
PHST- 2019/06/08 00:00 [accepted]
PHST- 2019/08/11 06:00 [pubmed]
PHST- 2020/03/03 06:00 [medline]
PHST- 2019/08/11 06:00 [entrez]
AID - S0022-5223(19)31211-5 [pii]
AID - 10.1016/j.jtcvs.2019.06.015 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2019 Oct;158(4):1199-1206. doi: 
      10.1016/j.jtcvs.2019.06.015. Epub 2019 Jun 15.