title: Signs of thrombin generation in pediatric cardiac catheterization with unfractionated heparin bolus or subcutaneous low molecular weight heparin for antithrombotic cover.
abstract: BACKGROUND
  Thrombosis is one of the most frequent adverse events after cardiac catheterization, which can be reduced by anticoagulation with unfractionated heparin (UFH) in both children and adults. Low molecular weight heparin (LMWH) might possibly offer advantages. Laboratory signs of thrombin generation during pediatric cardiac catheterization, with unfractionated heparin (UFH) bolus or subcutaneous LMWH for thrombosis prophylaxis, were determined in a first step to investigate the potential of LMWH for antithrombotic cover.
  
  
  METHODS
  Signs of thrombin generation (D-dimer and F1+2), anti-Xa activity and activated clotting time (ACT) were measured in 65 patients with congenital heart disease. A total of 40 patients were treated with a UFH bolus of 100 IU/kg bodyweight and, in 25 children, enoxaparin was subcutaneously administered at a dosage of 1/1.6 mg/kg bodyweight.
  
  
  RESULTS
  The dose to plasma activity of enoxaparin was more consistent than in the UFH group. Only a slight elevation of F1+2 was found in some patients, which was a little higher in the enoxaparin group, but no difference of incidence of increased F1+2 generation was detected between the two groups. D-dimer was elevated in three children after UFH bolus application, but no such effect was observed in any child after LMWH administration.
  
  
  CONCLUSIONS
  Application of LMWH was equally efficacious during pediatric cardiac catheterization than UFH bolus administration, as determined by plasma levels and markers of clotting activation. In contrast to UFH bolus, no further monitoring was necessary after the application of LMWH during cardiac catheterization due to a consistent dose to plasma activity.
authors.affiliation: Ludwig Boltzmann Research Institute for Pediatric Thrombosis and Hemostasis, Division of Pediatric Cardiology, Graz, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Roschitz
authors.forename: Albrecht
authors.initials: A
authors.lastname: Beitzke
authors.forename: Andreas
authors.initials: A
authors.lastname: Gamillscheg
authors.forename: Karl
authors.initials: K
authors.lastname: Sudi
authors.forename: Martin
authors.initials: M
authors.lastname: Koestenberger
authors.forename: Bettina
authors.initials: B
authors.lastname: Leschnik
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Muntean
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous; D008297:Male; D013917:Thrombin / Q000096:biosynthesis*; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D013917:Thrombin