Abstract | OBJECTIVE: DESIGN: Prospective cohort study. SETTING: Tertiary care academic center. PATIENTS: INTERVENTIONS: 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.
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Authors | Shilpa G Hundalani, Kim T Nguyen, Esther Soundar, Vadim Kostousov, Lisa Bomgaars, Alicia Moise, Shiu-Ki R Hui, Jun Teruya |
Journal | Pediatric 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 |
PMID | 24614609
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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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
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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)
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