title: Antithrombin concentrates use in children on extracorporeal membrane oxygenation: a retrospective cohort study.
abstract: OBJECTIVE
  To investigate whether receipt of any antithrombin concentrate improves laboratory and clinical outcomes in children undergoing extracorporeal membrane oxygenation for respiratory failure during their hospitalization compared with those who did not receive antithrombin.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single, tertiary-care pediatric hospital.
  
  
  METHODS
  Sixty-four neonatal and pediatric patients who underwent extracorporeal membrane oxygenation for respiratory failure between January 2007 and September 2011.
  
  
  METHODS
  Exposure to any antithrombin concentrate during their extracorporeal membrane oxygenation course compared with similar children who never received antithrombin concentrate.
  
  
  RESULTS
  Thirty patients received at least one dose of antithrombin during their extracorporeal membrane oxygenation course and 34 patients did not receive any. The median age at admission was less than 1-month old. Age, duration of extracorporeal membrane oxygenation, or first antithrombin level did not differ significantly between the two cohorts. The mean plasma antithrombin level in those who never received antithrombin was 42.2% compared with 66% in those who received it. However, few levels reached the targeted antithrombin level of 120% and those who did fell back to deficient levels within an average of 6.8 hours. For those who received antithrombin concentrate, heparin infusion rates decreased by an average of 10.2 U/kg/hr for at least 12 hours following administration. No statistical differences were noted in the number of extracorporeal membrane oxygenation circuit changes, in vivo clots or hemorrhages, transfusion requirements, hospital or ICU length of stay, or in-hospital mortality.
  
  
  CONCLUSIONS
  Intermittent, on-demand dosing of antithrombin concentrate in pediatric patients on extracorporeal membrane oxygenation for respiratory failure increased antithrombin levels, but not typically to the targeted level. Patients who received antithrombin concentrate also had decreased heparin requirements for at least 12 hours after dosing. However, no differences were noted in the measured clinical endpoints. A prospective, randomized study of this intervention may require different dosing strategies; such a study is warranted given the unproven efficacy of this costly product.
authors.affiliation: 1Division of Pediatric Hematology/Oncology and Department of Pathology, Oregon Health and Science University, Portland, OR. 2Puget Sound Blood Center, Seattle, WA. 3Department of Laboratory Medicine, University of Washington, Seattle, WA. 4Seattle Children's Hospital, Seattle, WA. 5Division of Hematology, Department of Medicine, University of Washington, Seattle, WA. 6Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA. 7Division of Pediatric Critical Care, University of Washington, Seattle, WA. 8Department of Surgery, University of Washington, Seattle, WA. 9Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Trisha E
authors.initials: TE
authors.lastname: Wong
authors.forename: Meghan
authors.initials: M
authors.lastname: Delaney
authors.forename: Terry
authors.initials: T
authors.lastname: Gernsheimer
authors.forename: Dana C
authors.initials: DC
authors.lastname: Matthews
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Robert
authors.initials: R
authors.lastname: Mazor
authors.forename: D Michael
authors.initials: DM
authors.lastname: McMullan
authors.forename: Alex P
authors.initials: AP
authors.lastname: Reiner
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Konkle
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012131:Respiratory Insufficiency / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006493:Heparin