Ghbeis Muhammad Bakr, Vander Pluym Christina J, Thiagarajan Ravi Ram
Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Division of Advanced Cardiac Therapies, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Front Pediatr. 2021 Feb 26;9:625632. doi: 10.3389/fped.2021.625632. eCollection 2021.
Ventricular assist devices (VAD) are used more in children. Safe and effective anticoagulation is required for successful management of children supported with ventricular assist devices. Developmental hemostasis, device hemocompatibility, plastic to body ratio, surgical variable techniques, lack of knowledge on pharmacokinetics of anticoagulants, and wide variability in anticoagulation protocols have all contributed to increased incidence of bleeding and thromboembolic complications. New collaborative learning networks, such as the ACTION network, provide opportunities to define best practices, optimize, and reduce anticoagulation related adverse events. ACTION was established Dec 2017. It consists of expert clinicians in heart failure, as well as researchers, parents, and patients, with goals to improve outcomes, share data, improve education and standard practice for children with heart failure (, n.d). Changes in pediatric VAD anticoagulation strategy from using mainly heparin to DTI such as bivalirudin have helped reduce bleeding and clotting complications.
心室辅助装置（VAD）在儿童中的应用更为广泛。对于接受心室辅助装置支持的儿童，成功管理需要安全有效的抗凝治疗。发育性止血、装置血液相容性、假体与身体比例、手术技术差异、对抗凝剂药代动力学缺乏了解以及抗凝方案的广泛差异，都导致了出血和血栓栓塞并发症的发生率增加。新的协作学习网络，如ACTION网络，提供了定义最佳实践、优化和减少抗凝相关不良事件的机会。ACTION于2017年12月成立。它由心力衰竭方面的专家临床医生以及研究人员、家长和患者组成，目标是改善心力衰竭儿童的治疗效果、共享数据、加强教育并规范治疗（日期不详）。儿科VAD抗凝策略从主要使用肝素转变为使用直接凝血酶抑制剂（DTI），如比伐芦定，有助于减少出血和凝血并发症。
