Challenges with heparin-based anticoagulation during cardiopulmonary bypass in children: Impact of low antithrombin activity Cedric Manlhiot, PhD, Colleen.

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Presentation transcript:

Challenges with heparin-based anticoagulation during cardiopulmonary bypass in children: Impact of low antithrombin activity Cedric Manlhiot, PhD, Colleen E. Gruenwald, MHSc, CCP, PhD, Helen M. Holtby, MB, BS, Leonardo R. Brandão, MSc, MD, Anthony K. Chan, MD, Glen S. Van Arsdell, MD, Brian W. McCrindle, MPH, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 2, Pages 444-450 (February 2016) DOI: 10.1016/j.jtcvs.2015.10.003 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Antithrombin activity by age at surgery. Blue circles represent individual patient values; solid lines show the estimates from regression models; and dotted lines show the 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 444-450DOI: (10.1016/j.jtcvs.2015.10.003) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Association between preoperative blood antithrombin activity and (left) heparin response (anti-Xa achieved after initial heparin bolus per 100 U/kg of heparin), and heparin dose (heparin used throughout CPB, indexed for patient weight and duration of cardiopulmonary support) (right). Blue circles represent individual patient values; solid lines show the estimates from regression models; and dotted lines show the 95% confidence interval. CPB, Cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 444-450DOI: (10.1016/j.jtcvs.2015.10.003) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Association between heparin dose throughout CPB indexed to (left) baseline antithrombin and minimum anti-Xa activity achieved throughout surgery, and (right) anti-Xa activity at the end of surgery. Blue circles represent individual patient values; solid lines show the estimates from regression models; and dotted lines show the 95% confidence interval. CPB, Cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 444-450DOI: (10.1016/j.jtcvs.2015.10.003) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Association between minimum anti-Xa activity achieved during the operation and thrombin generation post-CPB, as measured by thrombin-antithrombin complexes, prothrombin fragment 1.2, and maximum D-dimer measured 24 hours after CPB. Blue circles represent individual patient values; solid lines show the estimates from regression models; and dotted lines show the 95% confidence interval. CPB, Cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 444-450DOI: (10.1016/j.jtcvs.2015.10.003) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Low preoperative blood antithrombin activity is associated with decreased heparin response. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 444-450DOI: (10.1016/j.jtcvs.2015.10.003) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions