Issue |
J Extra Corpor Technol
Volume 42, Number 1, March 2010
|
|
---|---|---|
Page(s) | 9 - 19 | |
DOI | https://doi.org/10.1051/ject/201042009 | |
Published online | 15 March 2010 |
Review Article
Management and Monitoring of Anticoagulation for Children Undergoing Cardiopulmonary Bypass in Cardiac Surgery
* Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
† Division of Haematology/Oncology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
‡ Faculty of Science, School of Community Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
§ Division of Pediatric Haematology/Oncology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Canada
Address correspondence to: Colleen E. Gruenwald, MHSc, RN, CCP, CPC, Hospital for Sick Children, 555 University Avenue, Black Wing, Room 2324, Toronto, Ontario, M5G 1X8. E-mail: colleen.gruenwald@sickkids.ca
Received:
10
September
2009
Accepted:
21
December
2009
Cardiopulmonary bypass (CPB) creates a pro-coagulant state by causing platelet activation and inflammation leading to thrombin generation and platelet dysfunction. It is associated with severe derangements in normal homeostasis resulting in both thrombotic and hemorrhagic complications. This derangement is greater in children with congenital heart disease than in adults because of the immaturity of the coagulation system, hemodilution of coagulation factors, hyperreactive platelets, and in some patients, physiologic changes associated with cyanosis. During CPB, an appropriate amount of heparin is given with the goal of minimizing the risk of thrombosis and platelet activation and at the same time reducing the risk of bleeding from over anticoagulation. In young children, this balance is more difficult to achieve because of inherent characteristics of the hemostatic system in these patients. Historically, protocols for heparin dosing and monitoring in children have been adapted from adult protocols without re-validation for children. Extreme hemodilution of coagulation factors and platelets in young children affects the accuracy of anticoagulation monitoring in children. The activated clotting time does not correlate with plasma levels of heparin. In addition, recent studies suggest that children need larger doses of heparin than adults, because they have lower antithrombin levels, and they metabolize heparin more rapidly. Preliminary studies demonstrated that the use of individualized heparin and protamine monitoring and management in children is associated with reduced platelet activation and dysfunction and improved clinical outcomes. However, this review article clearly establishes that further studies are necessary to obtain evidence-based protocols for the proper management of anticoagulation of children undergoing cardiopulmonary bypass.
Key words: pediatrics / anticoagulation / cardiopulmonary bypass / homeostasis
© 2010 AMSECT
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.