Evaluation of Heparin Assay for Coagulation Management in Newborns Undergoing ECMO
The objective was to identify the usefulness of heparin level by anti-factor Xa (anti-Xa) assay vs activated partial thromboplastin time (PTT) or activated clotting time (ACT) in neonates undergoing extracorporeal membrane oxygenation (ECMO). A retrospective record review of 21 patients in the neona...
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| Veröffentlicht in: | American journal of clinical pathology 2010-12, Vol.134 (6), p.950-954 |
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| creator | KHAJA, Wassia A BILEN, Ozlem LUKNER, Ralf B EDWARDS, Rachel TERUYA, Jun |
| description | The objective was to identify the usefulness of heparin level by anti-factor Xa (anti-Xa) assay vs activated partial thromboplastin time (PTT) or activated clotting time (ACT) in neonates undergoing extracorporeal membrane oxygenation (ECMO). A retrospective record review of 21 patients in the neonatal intensive care unit (mean ECMO initiation age, 2 days; range, 0-4 days; male/female ratio, 1:1) undergoing ECMO from 2006 to 2008 was performed. Linear regression correlations between anti-Xa, PTT, and ACT were determined by extrapolating PTT and ACT therapeutic ranges that corresponded with the ECMO heparin target range of 0.3 to 0.6 U/mL. Pearson correlation coefficients between heparin levels and PTT (-0.903 to 0.984), PTT less than 40 seconds after correction using PTT-heparinase (-0.903 to 1.000), and ACT (-0.951 to 0.891) in this patient population were widely variable. Inconsistency of PTT and ACT therapeutic ranges corresponding to heparin levels of 0.3 to 0.6 U/mL prompts a multifactorial approach to ECMO management because no single laboratory test can be used to determine appropriate anticoagulation management. |
| doi_str_mv | 10.1309/ajcpgvd62lkkvdlh |
| format | Article |
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A retrospective record review of 21 patients in the neonatal intensive care unit (mean ECMO initiation age, 2 days; range, 0-4 days; male/female ratio, 1:1) undergoing ECMO from 2006 to 2008 was performed. Linear regression correlations between anti-Xa, PTT, and ACT were determined by extrapolating PTT and ACT therapeutic ranges that corresponded with the ECMO heparin target range of 0.3 to 0.6 U/mL. Pearson correlation coefficients between heparin levels and PTT (-0.903 to 0.984), PTT less than 40 seconds after correction using PTT-heparinase (-0.903 to 1.000), and ACT (-0.951 to 0.891) in this patient population were widely variable. Inconsistency of PTT and ACT therapeutic ranges corresponding to heparin levels of 0.3 to 0.6 U/mL prompts a multifactorial approach to ECMO management because no single laboratory test can be used to determine appropriate anticoagulation management.</description><identifier>ISSN: 0002-9173</identifier><identifier>EISSN: 1943-7722</identifier><identifier>DOI: 10.1309/ajcpgvd62lkkvdlh</identifier><identifier>PMID: 21088159</identifier><identifier>CODEN: AJCPAI</identifier><language>eng</language><publisher>Chicago, IL: American Society of Clinical Pathologists</publisher><subject>Anticoagulants - administration & dosage ; Anticoagulants - blood ; Biological and medical sciences ; Extracorporeal Membrane Oxygenation ; Factor Xa - analysis ; Female ; Heparin - administration & dosage ; Heparin - blood ; Hernia, Diaphragmatic - therapy ; Humans ; Hypertension, Pulmonary - therapy ; Infant, Newborn ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Meconium Aspiration Syndrome - therapy ; Medical sciences ; Partial Thromboplastin Time ; Pathology. 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A retrospective record review of 21 patients in the neonatal intensive care unit (mean ECMO initiation age, 2 days; range, 0-4 days; male/female ratio, 1:1) undergoing ECMO from 2006 to 2008 was performed. Linear regression correlations between anti-Xa, PTT, and ACT were determined by extrapolating PTT and ACT therapeutic ranges that corresponded with the ECMO heparin target range of 0.3 to 0.6 U/mL. Pearson correlation coefficients between heparin levels and PTT (-0.903 to 0.984), PTT less than 40 seconds after correction using PTT-heparinase (-0.903 to 1.000), and ACT (-0.951 to 0.891) in this patient population were widely variable. Inconsistency of PTT and ACT therapeutic ranges corresponding to heparin levels of 0.3 to 0.6 U/mL prompts a multifactorial approach to ECMO management because no single laboratory test can be used to determine appropriate anticoagulation management.</description><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - blood</subject><subject>Biological and medical sciences</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Factor Xa - analysis</subject><subject>Female</subject><subject>Heparin - administration & dosage</subject><subject>Heparin - blood</subject><subject>Hernia, Diaphragmatic - therapy</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - therapy</subject><subject>Infant, Newborn</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Meconium Aspiration Syndrome - therapy</subject><subject>Medical sciences</subject><subject>Partial Thromboplastin Time</subject><subject>Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sepsis - therapy</subject><subject>Whole Blood Coagulation Time</subject><issn>0002-9173</issn><issn>1943-7722</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0D1PwzAQBmALgaB87EwoC2IK-CNx7LEKhQItRQhYo0tsh0BqF7sp4t8T1ALD6ZbnfaU7hI4JPicMywt4qxb1SnHavr-vVPu6hQZEJizOMkq30QBjTGNJMraH9kN4w5hQgZNdtEcJFoKkcoAeRytoO1g2zkbORGO9AN_YaBgCfEXG-Sh3UHftGkzBQq3n2i6j3tzrz9J5G6Jnq7SvXWPraJRPZ4dox0Ab9NFmH6Cnq9FTPo4ns-ubfDiJq4TxZWxomQqmShClYKmsiEk5EbJUUolEVUSXjCtCZMYVaAoGp7ofk4rMQMYFO0Bn69qFdx-dDsti3oRKty1Y7bpQCCwSzhIhe4nXsvIuBK9NsfDNHPxXQXDx88dieJs_XL9ccjq5u3u5nIz7yMmmvCvnWv0Ffh_Xg9MNgFBBazzYqgn_jvU3JpyybzslfgA</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>KHAJA, Wassia A</creator><creator>BILEN, Ozlem</creator><creator>LUKNER, Ralf B</creator><creator>EDWARDS, Rachel</creator><creator>TERUYA, Jun</creator><general>American Society of Clinical Pathologists</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101201</creationdate><title>Evaluation of Heparin Assay for Coagulation Management in Newborns Undergoing ECMO</title><author>KHAJA, Wassia A ; BILEN, Ozlem ; LUKNER, Ralf B ; EDWARDS, Rachel ; TERUYA, Jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-f2b583dba8b8359c1f56189bd9d84dc1eb36d11976dae2af05ef05f587fa7683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - blood</topic><topic>Biological and medical sciences</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Factor Xa - analysis</topic><topic>Female</topic><topic>Heparin - administration & dosage</topic><topic>Heparin - blood</topic><topic>Hernia, Diaphragmatic - therapy</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - therapy</topic><topic>Infant, Newborn</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Meconium Aspiration Syndrome - therapy</topic><topic>Medical sciences</topic><topic>Partial Thromboplastin Time</topic><topic>Pathology. 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Miscellaneous investigative techniques</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Sepsis - therapy</topic><topic>Whole Blood Coagulation Time</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KHAJA, Wassia A</creatorcontrib><creatorcontrib>BILEN, Ozlem</creatorcontrib><creatorcontrib>LUKNER, Ralf B</creatorcontrib><creatorcontrib>EDWARDS, Rachel</creatorcontrib><creatorcontrib>TERUYA, Jun</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of clinical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KHAJA, Wassia A</au><au>BILEN, Ozlem</au><au>LUKNER, Ralf B</au><au>EDWARDS, Rachel</au><au>TERUYA, Jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of Heparin Assay for Coagulation Management in Newborns Undergoing ECMO</atitle><jtitle>American journal of clinical pathology</jtitle><addtitle>Am J Clin Pathol</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>134</volume><issue>6</issue><spage>950</spage><epage>954</epage><pages>950-954</pages><issn>0002-9173</issn><eissn>1943-7722</eissn><coden>AJCPAI</coden><abstract>The objective was to identify the usefulness of heparin level by anti-factor Xa (anti-Xa) assay vs activated partial thromboplastin time (PTT) or activated clotting time (ACT) in neonates undergoing extracorporeal membrane oxygenation (ECMO). A retrospective record review of 21 patients in the neonatal intensive care unit (mean ECMO initiation age, 2 days; range, 0-4 days; male/female ratio, 1:1) undergoing ECMO from 2006 to 2008 was performed. Linear regression correlations between anti-Xa, PTT, and ACT were determined by extrapolating PTT and ACT therapeutic ranges that corresponded with the ECMO heparin target range of 0.3 to 0.6 U/mL. Pearson correlation coefficients between heparin levels and PTT (-0.903 to 0.984), PTT less than 40 seconds after correction using PTT-heparinase (-0.903 to 1.000), and ACT (-0.951 to 0.891) in this patient population were widely variable. 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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals |
| subjects | Anticoagulants - administration & dosage Anticoagulants - blood Biological and medical sciences Extracorporeal Membrane Oxygenation Factor Xa - analysis Female Heparin - administration & dosage Heparin - blood Hernia, Diaphragmatic - therapy Humans Hypertension, Pulmonary - therapy Infant, Newborn Investigative techniques, diagnostic techniques (general aspects) Male Meconium Aspiration Syndrome - therapy Medical sciences Partial Thromboplastin Time Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques Reproducibility of Results Retrospective Studies Sepsis - therapy Whole Blood Coagulation Time |
| title | Evaluation of Heparin Assay for Coagulation Management in Newborns Undergoing ECMO |
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