A continuous heparin infusion does not prevent catheter-related thrombosis in infants after cardiac surgery.
OBJECTIVE
To determine whether a continuous infusion of heparin reduces the rate of catheter-related thrombosis in neonates and infants post cardiac surgery. Central venous and intracardiac catheters are used routinely in postoperative pediatric cardiac patients. Catheter-related thrombosis occurs in 8% to 45% of pediatric patients with central venous catheters.


METHODS
Single-center, randomized, placebo-controlled, double-blinded trial.


METHODS
Cardiovascular intensive care unit, university-affiliated children's hospital.


METHODS
Children <1 yr of age recovering from cardiac surgery.


METHODS
Patients were randomized to receive either continuous heparin at 10 units/kg/hr or placebo. The primary end point was catheter-related thrombosis as assessed by serial ultrasonography.


RESULTS
Study enrollment was discontinued early based on results from an interim futility analysis. Ninety subjects were enrolled and received the study drug (heparin, 53; placebo, 37). The catheter-related thrombosis rate in the heparin group, compared with the placebo group, was 15% vs. 16% (p = .89). Subjects in the heparin group had a higher mean partial thromboplastin time (52 secs vs. 42 secs, p = .001), and this difference was greater for those aged <30 days (64 secs vs. 43 secs, p = .008). Catheters in place > or = 7 days had both a greater risk of thrombus formation (odds ratio, 4.3; p = .02) and catheter malfunction (odds ratio, 11.2; p = .008). We observed no significant differences in other outcome measures or in the frequency of adverse events.


CONCLUSIONS
A continuous infusion of heparin at 10 units/kg/hr was safe but did not reduce catheter-related thrombus formation. Heparin at this dose caused an increase in partial thromboplastin time values, which, unexpectedly, was more pronounced in neonates.
Schroeder
Alan R
AR
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. Alan.Schroeder@hhs.sccgov.org
Axelrod
David M
DM
Silverman
Norman H
NH
Rubesova
Erika
E
Merkel
Elisabeth
E
Roth
Stephen J
SJ
D000925:Anticoagulants / Q000008:administration & dosage* / Q000494:pharmacology; D002404:Catheterization / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D011183:Postoperative Complications / Q000097:blood; D013903:Thoracic Surgery; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome; D014463:Ultrasonography
D000925:Anticoagulants; D006493:Heparin