title: Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation.
abstract: BACKGROUND
  We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3.
  
  
  RESULTS
  Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups.
  
  
  CONCLUSIONS
  Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA; Vascular Biology Center, Augusta University, Augusta, GA, USA. Electronic address: bstansfield@augusta.edu.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Stansfield
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Wise
authors.affiliation: Department of Surgery, Augusta University, Augusta, GA, USA.
authors.forename: P Benson
authors.initials: PB
authors.lastname: Ham
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA.
authors.forename: Pinkal
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA.
authors.forename: Malinda
authors.initials: M
authors.lastname: Parman
authors.affiliation: Department of Biostatistics and Epidemiology, Augusta University, Augusta, GA.
authors.forename: Chan
authors.initials: C
authors.lastname: Jin
authors.affiliation: Department of Biostatistics and Epidemiology, Augusta University, Augusta, GA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA; Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Harshfield
authors.affiliation: Department of Pediatrics, Augusta University, Augusta, GA, USA.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Bhatia
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D000990:Antithrombin III / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000990:Antithrombin III; D006493:Heparin
keywords: Antithrombin III; Bleeding; Coagulation; ECMO; Neonatal; Thrombosis