Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2017; 9(9): 749-756
Published online Sep 26, 2017. doi: 10.4330/wjc.v9.i9.749
Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices
Ajay K Bhatia, Mouhammad Yabrodi, Mallory Carroll, Silvia Bunting, Kirk Kanter, Kevin O Maher, Shriprasad R Deshpande
Ajay K Bhatia, Mouhammad Yabrodi, Kevin O Maher, Shriprasad R Deshpande, Division of Pediatric Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, United States
Mallory Carroll, Mechanical Circulatory Support Program, Children’s Healthcare of Atlanta, Atlanta, GA 30322, United States
Silvia Bunting, Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, United States
Kirk Kanter, Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Bhatia AK and Yabrodi M contributed to data collection, writing manuscript; Carroll M contributed to clinical care and data, oversight; Bunting S contributed to laboratory oversight, technical writing and oversight; Kanter K contributed to surgical care, overnight and critical review; Maher KO contributed to critical care, study oversight and critical review; Deshpande SR contributed to study design and concept, oversight and manuscript writing and final edits.
Institutional review board statement: Study was reviewed and approved by the Institutional Review Board at Children’s Healthcare of Atlanta.
Informed consent statement: Not applicable, retrospective study. Institutional review board waived need for consent for retrospective study.
Conflict-of-interest statement: The authors have no conflicts of interest or financial disclosures. No funding source to disclose.
Data sharing statement: Not applicable.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shriprasad R Deshpande, MBBS, MS, Division of Pediatric Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, 1405, Clifton Rd NE, Atlanta, GA 30322, United States. deshpandes@kidsheart.com
Telephone: +1-404-6947739 Fax: +1-770-4889480
Received: January 12, 2017
Peer-review started: January 16, 2017
First decision: May 11, 2017
Revised: July 20, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: September 26, 2017
Processing time: 255 Days and 15.5 Hours
Abstract
AIM

To assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device (VAD).

METHODS

Retrospective study of pediatric patients supported with a Berlin EXCOR VAD at a single pediatric tertiary care center during a single year.

RESULTS

We demonstrated associations between activated thromboplastin time (aPTT) and R-thromboelastography (R-TEG) values (rs = 0.65, P < 0.001) and between anti-Xa assay and R-TEG values (rs = 0.54, P < 0.001). The strongest correlation was seen between aPTT and anti-Xa assays (rs = 0.71, P < 0.001). There was also a statistically significant correlation between platelet counts and the maximum amplitude of TEG (rs = 0.71, P < 0.001). Importantly, there was no association between dose of unfractionated heparin and either measure of anticoagulation (aPTT, anti-Xa or R-TEG value).

CONCLUSION

This study suggests that while there is strong correlation between aPTT, anti-Xa assay and R-TEG values for patients requiring VAD support, there is a lack of relevant correlation between heparin dose and degree of effect. This raises concern as various guidelines continue to recommend using these parameters to titrate heparin therapy.

Keywords: Ventricular assist device; Anticoagulation; BERLIN-EXCOR; Pediatric; Thromboelastography

Core tip: This study suggests that while there is strong correlation between activated thromboplastin time, anti-Xa assay and R-thromboelastography values for patients requiring ventricular assist device support, there is a lack of relevant correlation between heparin dose and degree of effect. This raises concern as various guidelines continue to recommend using these parameters to titrate heparin therapy. A comprehensive strategy for appropriate anticoagulation may therefore warrant a combination of parameter monitoring and warrants further study.