1Department of Cardiovascular and Thoracic Surgery, The Children's Hospital at Montefiore, Montefiore Medical Center, Bronx, NY. 2Division of Hematology-Oncology, The Children's Hospital at Montefiore, Bronx, NY. 3Division of Pediatric Critical Care, The Children's Hospital at Montefiore, Bronx, NY.
Pediatr Crit Care Med. 2014 Feb;15(2):e72-9. doi: 10.1097/PCC.0000000000000028.
To assess the utility of activated clotting time, activated partial thromboplastin time, and anti-Factor Xa assay for the monitoring and dosing of heparin in pediatric patients requiring support with extracorporeal membrane oxygenation.
Retrospective chart review.
PICU in a single, tertiary care, academic children's hospital.
Seventeen patients (age 1 d to 13.9 yr, median 0.83 yr) managed on pulmonary and cardiac extracorporeal membrane oxygenation between March 2010 and August 2012 by a single surgeon.
None.
Twice daily measurements of anti-Factor Xa assay, activated clotting time, and activated partial thromboplastin time were determined from the same blood specimen. Data were analyzed using SAS system v9.2. Fourteen patients (82.4%) were successfully weaned from extracorporeal membrane oxygenation and 12 (70.6%) were discharged from the hospital. Pearson correlations were used to compare heparin dose and activated clotting time, activated partial thromboplastin time, and anti-Factor Xa assay. Analysis showed negative Pearson correlations in 11 of 17 patients between the activated clotting time and heparin, as compared with seven of 17 for activated partial thromboplastin time and only one for heparin and anti-Factor Xa assay. Only four patients had moderate to strong positive correlations between activated clotting time and heparin as compared with a moderate to strong positive correlation in 10 patients for anti-Factor Xa assay and heparin.
The anti-Factor Xa assay correlated better with heparin dosing than activated clotting time or activated partial thromboplastin time. Activated clotting time has a poor correlation to heparin doses commonly associated with extracorporeal membrane oxygenation. In pediatric extracorporeal membrane oxygenation, anti-Factor Xa assay may be a more valuable monitor of heparin administration.
评估激活凝血时间、激活部分凝血活酶时间和抗因子 Xa 测定在需要体外膜肺氧合支持的儿科患者中监测和调整肝素剂量的作用。
回顾性图表审查。
一家单中心、三级保健、学术儿童医院的 PICU。
2010 年 3 月至 2012 年 8 月，由一名外科医生对 17 名（年龄 1 天至 13.9 岁，中位数 0.83 岁）接受肺和心脏体外膜肺氧合治疗的患者进行管理。
无。
从同一份血样中两次每日测量抗因子 Xa 测定、激活凝血时间和激活部分凝血活酶时间。使用 SAS 系统 v9.2 分析数据。14 名患者（82.4%）成功地从体外膜肺氧合中脱机，12 名（70.6%）从医院出院。使用 Pearson 相关系数比较肝素剂量和激活凝血时间、激活部分凝血活酶时间和抗因子 Xa 测定。分析显示，在 17 名患者中，有 11 名患者的激活凝血时间与肝素呈负相关，而 17 名患者中有 7 名患者的激活部分凝血活酶时间与肝素呈负相关，而肝素与抗因子 Xa 测定的相关性仅为 1 名。只有 4 名患者的激活凝血时间与肝素之间存在中度至强正相关，而 10 名患者的抗因子 Xa 测定与肝素之间存在中度至强正相关。
抗因子 Xa 测定与肝素剂量的相关性优于激活凝血时间或激活部分凝血活酶时间。激活凝血时间与体外膜肺氧合常用的肝素剂量相关性差。在儿科体外膜肺氧合中，抗因子 Xa 测定可能是监测肝素给药的更有价值的指标。
