Colin Rogerson, MD
Indiana University School of Medicine, Riley Hospital for Children
Indianapolis, Indiana
Disclosure information not submitted.
Hobson Michael, MD
Associate Professor of Clinical Pediatrics
Indiana University School of Medicine, United States
Disclosure information not submitted.
Title: The Heparin-Antithrombin Product: a Novel Value for Pediatric Extracorporeal Anticoagulation
Introduction: Hematologic complications are a major source of morbidity and mortality for patients receiving extracorporeal membrane oxygenation (ECMO) support. There is no consensus laboratory strategy for monitoring anticoagulation for children supported with ECMO. This study evaluated the utility of a novel measurement of anticoagulation for children on ECMO.
Methods: This was a single-center observational study of children supported with ECMO from 2015-2020. The patient’s current unfractionated heparin dose was multiplied by the patient’s current anti-thrombin III (AT3) level to obtain a novel anticoagulation value, the heparin-antithrombin product (HAP). This value was compared with heparin dose, AT3, and activated clotting time (ACT) to predict anti-Xa value using linear correlation, a non-parametric smoothing spline, a generalized additive model, a regression tree model, and a random forest model.
Results: Daily laboratory and medication data were obtained from 128 pediatric patients supported with ECMO. The HAP value was more highly correlated with anti-Xa level than heparin dose, AT3 level, and ACT. This correlation was highest in the neonatal population (r=0.7). The variable importance metrics from the regression tree and random forest models both identified the HAP value as the most influential predictor variable for anti-Xa value.
Conclusion: The HAP value, a novel anticoagulation metric, is more highly correlated with anti-Xa level than heparin dose, AT3 level, or ACT. This may be useful as a measurement of anticoagulation for children on ECMO.