HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Age-based difference in activation markers of coagulation and fibrinolysis in extracorporeal membrane oxygenation.

AbstractOBJECTIVE:
Coagulation system activation in extracorporeal membrane oxygenation results in hemostatic derangements. Thrombin generation markers like prothrombin fragment 1+2 and thrombin-antithrombin complex are sensitive markers of hypercoagulability. Plasmin-antiplasmin complex is a sensitive marker for fibrinolysis. D-dimers reflect thrombin generation and fibrinolysis. The aim was to identify the extent of hemostasis activation during extracorporeal membrane oxygenation by measuring thrombin-antithrombin complex, prothrombin fragment 1+2, plasmin-antiplasmin complex, and D-dimer.
DESIGN:
Prospective cohort study.
SETTING:
Tertiary care academic center.
PATIENTS:
Children placed on extracorporeal membrane oxygenation from April 2011 to January 2013.
INTERVENTIONS:
Prothrombin fragment 1+2, thrombin-antithrombin complex, plasmin-antiplasmin complex, and D-dimer were measured on days 1 and 5 of extracorporeal membrane oxygenation.
MEASUREMENTS AND MAIN RESULTS:
Data presented as median (interquartile range); nonparametric tests were done using SPSS. Twenty-nine children (52% < 30 d old [neonates], median extracorporeal membrane oxygenation length 151 hr) were studied. Complications included thrombosis in 14%, bleeding in 45%, and thrombosis and bleeding together in 10%. Thrombin-antithrombin complex, prothrombin fragment 1+2, plasmin-antiplasmin complex, and D-dimer levels were high on day 1 and remained increased on extracorporeal membrane oxygenation. In neonates, all levels were higher on day 5 compared with day 1: thrombin-antithrombin complex (55.6 μg/L [30.7-76.0] vs 18.7 μg/L [10.9-34.6]; p = 0.03), prothrombin fragment 1+2 (2,038 pmol/L [1,093-4,018.5] vs 377.5 pmol/L [334.3-1,103.0]; p = 0.00), plasmin-antiplasmin complex (2,160 μg/L [786-3,090] vs 398 μg/L [296.8-990.8]; p = 0.00), and D-dimer (3.0 μg/mL [1.9-11.5] vs 1.5 μg/mL [0.6-2.9]; p = 0.01). Thrombin-antithrombin complex, prothrombin fragment 1+2, plasmin-antiplasmin complex, and D-dimer levels did not correlate with anti-Xa activity or heparin dose. In bleeders older than 30 days, plasmin-antiplasmin complex stayed elevated on day 5, but in patients with no bleeding complications, plasmin-antiplasmin level showed a declining trend. In neonates, plasmin-antiplasmin levels increased over the course of extracorporeal membrane oxygenation irrespective of bleeding.
CONCLUSION:
Despite our best efforts at adequate anticoagulation with unfractionated heparin, neonates showed persistent increase in coagulation activation on extracorporeal membrane oxygenation. Fibrinolysis activation may contribute to bleeding in patients older than 30 days. Different anticoagulation protocols should be individualized based on age.
AuthorsShilpa G Hundalani, Kim T Nguyen, Esther Soundar, Vadim Kostousov, Lisa Bomgaars, Alicia Moise, Shiu-Ki R Hui, Jun Teruya
JournalPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 15 Issue 5 Pg. e198-205 (Jun 2014) ISSN: 1529-7535 [Print] United States
PMID24614609 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anticoagulants
  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Peptide Fragments
  • alpha-2-Antiplasmin
  • antithrombin III-protease complex
  • fibrin fragment D
  • plasmin-plasmin inhibitor complex
  • prothrombin fragment 1.2
  • Antithrombin III
  • Prothrombin
  • Heparin
  • Peptide Hydrolases
  • Fibrinolysin
Topics
  • Age Factors
  • Anticoagulants (administration & dosage)
  • Antithrombin III
  • Biomarkers (blood)
  • Blood Coagulation (physiology)
  • Extracorporeal Membrane Oxygenation (adverse effects)
  • Female
  • Fibrin Fibrinogen Degradation Products (metabolism)
  • Fibrinolysin (metabolism)
  • Fibrinolysis (physiology)
  • Hemorrhage (blood, etiology)
  • Heparin (administration & dosage)
  • Humans
  • Infant, Newborn
  • Male
  • Peptide Fragments (blood)
  • Peptide Hydrolases (blood)
  • Prospective Studies
  • Prothrombin
  • Thrombosis (blood, etiology)
  • Time Factors
  • alpha-2-Antiplasmin (metabolism)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: