title: Evaluation of heparin assay for coagulation management in newborns undergoing ECMO.
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. 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.
authors.affiliation: Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Wassia A
authors.initials: WA
authors.lastname: Khaja
authors.forename: Ozlem
authors.initials: O
authors.lastname: Bilen
authors.forename: Ralf B
authors.initials: RB
authors.lastname: Lukner
authors.forename: Rachel
authors.initials: R
authors.lastname: Edwards
authors.forename: Jun
authors.initials: J
authors.lastname: Teruya
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000097:blood*; D015199:Extracorporeal Membrane Oxygenation; D015951:Factor Xa / Q000032:analysis*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000097:blood*; D006548:Hernia, Diaphragmatic / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000628:therapy; D010314:Partial Thromboplastin Time; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006493:Heparin; D015951:Factor Xa