Supplemental Antithrombin Is Effective in Achieving Adequate Anticoagulation in Infants and Children With an Inadequate Response to Heparin

Objective: To demonstrate that supplemental antithrombin (AT) is effective in establishing adequate anticoagulation in infants and children with initially inadequate responses to heparin. Design: Following institutional review board approval, a retrospective chart review was conducted on pediatric patients receiving AT during cardiac surgery requiring cardiopulmonary bypass. Setting: A single institutional review in a hospital setting. Participants: Thirty-one pediatric patients with age ranging from 1 day to 36 months (median 12 weeks) receiving AT during the study period. Interventions: As this was a retrospective chart review, no active interventions on patients were performed. Measurements and Main Results: Data collected included: patient age, sex, weight, activated clotting time (ACT) values, as well as heparin and AT doses. Primary outcomes were the increase in the ACT from pre- to post-AT and the number of patients who achieved an ACT > 480 seconds. The paired t-test was used to compare pre- and post-AT ACT. Mean dose of AT was 50 U/kg (standard deviation 6). Following administration of AT, 30 pediatric patients achieved an ACT of > 480 seconds. The post-AT ACT was significantly higher than the pre-AT by a mean of 327 seconds (p < 0.0001); 96% of patients achieved an adequate ACT to initiate cardiopulmonary bypass. No adverse events attributable to AT were recorded. Conclusion: AT was effective in achieving adequate anticoagulation in a small cohort of infants and children undergoing cardiac surgery who initially were poorly responsive to heparin. Further research to examine the utility of AT in improving clinical outcomes is warranted. (C) 2017 Elsevier Inc. All rights reserved.