PMID- 36311559
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230105
IS  - 2639-8028 (Electronic)
IS  - 2639-8028 (Linking)
VI  - 4
IP  - 10
DP  - 2022 Oct
TI  - Novel Coagulation Test Detects Anticoagulation Resistance and Is Associated With 
      Thrombotic Events in Pediatric Patients Requiring Extracorporeal Membrane 
      Oxygenation.
PG  - e0776
LID - 10.1097/CCE.0000000000000776 [doi]
LID - e0776
AB  - Bivalirudin, an IV direct thrombin inhibitor, and unfractionated heparin (UFH) 
      are frequently used anticoagulants in the pediatric critical care setting. An 
      accurate, specific, point-of-care test to quantify and detect anticoagulation 
      resistance is not currently available. This study evaluates the ability of a 
      rapid (< 10 min), micro-volume (< 50 uL) coagulation test to detect and quantify 
      the anticoagulation effect of bivalirudin and UFH using a functional, clot time 
      endpoint in pediatric critical care patients. DESIGN: Single-site retrospective 
      laboratory sample analysis and chart review. SETTING: A 105-bed pediatric and 
      cardiac ICUs delivering extracorporeal membrane oxygenation. SUBJECTS: Forty-one 
      citrated, frozen, biobanked plasma specimens comprising 21 with bivalirudin and 
      20 with UFH from 15 anticoagulated pediatric patients were analyzed. Thirteen 
      patients were on extracorporeal membrane oxygenation, one had a submassive 
      pulmonary embolism, and one was on a left ventricular assist device. 
      INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A Clotting Time Score (CTS) 
      was derived on each sample. The CTS detected patients that had developed a 
      pathologic clotting event with 100% sensitivity and 82% specificity compared with 
      prothrombin time with 25% sensitivity/76% specificity and activated partial 
      thromboplastin time with 0% sensitivity/0% specificity. Additionally, the CTS 
      detected subtherapeutic anticoagulation in response to UFH in patients that were 
      clinically determined to be UFH resistant requiring alternative anticoagulation 
      with bivalirudin. CONCLUSIONS: The CTS appears to be a clinically valuable 
      indicator of coagulation status in patients treated with either UFH or 
      bivalirudin. Results outside of the therapeutic range due to inadequate dosing or 
      anticoagulation resistance appeared to be associated with clot formation. CTS 
      testing may reduce the risk of anticoagulation-related complications via the 
      rapid identification of patients at high risk for pathologic thrombotic events.
CI  - Copyright (c) 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
      of the Society of Critical Care Medicine.
FAU - Frydman, Galit H
AU  - Frydman GH
AD  - Coagulo Medical Technologies, Inc., Auburndale, MA.
FAU - Berger, Barry M
AU  - Berger BM
AD  - Coagulo Medical Technologies, Inc., Auburndale, MA.
FAU - Kostousov, Vadim
AU  - Kostousov V
AD  - Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, TX.
FAU - Bruzdovski, Karen
AU  - Bruzdovski K
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, TX.
FAU - Papageorgiou, Dimitrios P
AU  - Papageorgiou DP
AD  - Coagulo Medical Technologies, Inc., Auburndale, MA.
FAU - Navaei, Amir
AU  - Navaei A
AD  - Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, TX.
FAU - Hui, Shiu-Ki Rocky
AU  - Hui SR
AD  - Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, TX.
FAU - Teruya, Jun
AU  - Teruya J
AD  - Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, TX.
AD  - Department of Anesthesiology, Baylor College of Medicine, Houston, TX.
AD  - Department of Medicine, Baylor College of Medicine, Houston, TX.
LA  - eng
PT  - Journal Article
DEP - 20221025
PL  - United States
TA  - Crit Care Explor
JT  - Critical care explorations
JID - 101746347
EIN - Crit Care Explor. 2022 Dec 28;5(1):e0836. PMID: 36600783
PMC - PMC9605743
OTO - NOTNLM
OT  - ECMO
OT  - VAD
OT  - anticoagulation
OT  - bivalirudin
OT  - heparin
OT  - thrombosis
COIS- Dr. Frydman is the Chief Scientific Officer of Coagulo Medical Technologies. Dr. 
      Berger is the Chief Medical Officer of Coagulo Medical Technologies. Dr. 
      Papageorgiou is a scientist at Coagulo Medical Technologies. Dr. Teruya is a 
      consultant of Agios and Apelo and a board member of Data Safety Monitoring of 
      Evaheart. The remaining authors have disclosed that they do not have any 
      potential conflicts of interest.
EDAT- 2022/11/01 06:00
MHDA- 2022/11/01 06:01
PMCR- 2022/10/25
CRDT- 2022/10/31 04:23
PHST- 2022/10/31 04:23 [entrez]
PHST- 2022/11/01 06:00 [pubmed]
PHST- 2022/11/01 06:01 [medline]
PHST- 2022/10/25 00:00 [pmc-release]
AID - 10.1097/CCE.0000000000000776 [doi]
PST - epublish
SO  - Crit Care Explor. 2022 Oct 25;4(10):e0776. doi: 10.1097/CCE.0000000000000776. 
      eCollection 2022 Oct.