Bhatia AK, Yabrodi M, Carroll M, Bunting S, Kanter K, Maher KO, Deshpande SR. Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices. World J Cardiol 2017; 9(9): 749-756 [PMID: 29081908 DOI: 10.4330/wjc.v9.i9.749]
Corresponding Author of This Article
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
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
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Bhatia AK, Yabrodi M, Carroll M, Bunting S, Kanter K, Maher KO, Deshpande SR. Utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist devices. World J Cardiol 2017; 9(9): 749-756 [PMID: 29081908 DOI: 10.4330/wjc.v9.i9.749]
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.
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.
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.
