Moffett Brady S, Cabrera Antonio G, Teruya Jun, Bomgaars Lisa
From the *Department of Pharmacy, Texas Children's Hospital, Houston, Texas; †Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; ‡Departments of Pathology and Immunology, Pediatrics, and Medicine, Baylor College of Medicine, Houston, Texas; and §Section of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
ASAIO J. 2014 Mar-Apr;60(2):211-5. doi: 10.1097/MAT.0000000000000037.
Ventricular assist device (VAD) use in children has increased dramatically. There are currently few data regarding trends in anticoagulation management for pediatric VADs. A retrospective cohort study was conducted for patients with an International Classification of Diseases, Ninth Revision (ICD-9) code for VAD implantation from 2000 to 2011 from the Pediatric Health Information System database. Patient demographics, use of extracorporeal membrane oxygenation, orthotopic heart transplantation (OHT), disease states, and medications pertinent to the management of VAD anticoagulation were queried. Patients were grouped into 3 year time periods to evaluate trends in medication use over time. Four hundred sixty-six patients were identified with a median length of VAD therapy of 21 days (range 1-362 days). In-hospital mortality was 31.9%, and 54.5% underwent OHT. Length of VAD therapy and patients undergoing OHT increased, while mortality decreased. Patients received a median of two anticoagulant medications (range 0-6), one (range 0-4) antiplatelet medications, three (range 0-5) procoagulant medications, and one (range 0-3) antifibrinolytics. Patients received greater mean numbers of anticoagulant, procoagulant, antifibrinolytic, and antiplatelet agents, and the use of oral medications increased more than twofold over time. There is wide variability for in-hospital pediatric VAD anticoagulation management, with a significant increase in the use of oral agents in more recent years.
儿童心室辅助装置（VAD）的使用已大幅增加。目前，关于小儿VAD抗凝管理趋势的数据较少。我们对2000年至2011年来自儿科健康信息系统数据库、具有国际疾病分类第九版（ICD - 9）VAD植入代码的患者进行了一项回顾性队列研究。查询了患者的人口统计学资料、体外膜肺氧合的使用情况、原位心脏移植（OHT）、疾病状态以及与VAD抗凝管理相关的药物。将患者按3年时间段分组，以评估随时间推移药物使用的趋势。共确定了466例患者，VAD治疗的中位时长为21天（范围1 - 362天）。住院死亡率为31.9%，54.5%的患者接受了OHT。VAD治疗时长和接受OHT的患者数量增加，而死亡率下降。患者接受的抗凝药物中位数为两种（范围0 - 6种）、抗血小板药物一种（范围0 - 4种）、促凝药物三种（范围0 - 5种）以及抗纤溶药物一种（范围0 - 3种）。患者接受的抗凝、促凝、抗纤溶和抗血小板药物的平均数量更多，并且随着时间推移口服药物的使用增加了两倍多。小儿VAD住院抗凝管理存在很大差异，近年来口服药物的使用显著增加。
