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 V...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 thro-mboplastin time(a PTT)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 a PTT 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(a PTT,anti-Xa or R-TEG value).CONCLUSION This study suggests that while there is strong correlation between a PTT,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.展开更多
BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement.This complication is more serious among patients with single ventricle physiology,as it ...BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement.This complication is more serious among patients with single ventricle physiology,as it might preclude them from undergoing further life-sustaining palliative surgery.AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters(PICCs)in children with single ventricle physiology.METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure.Clinical data including ultrasonography,cardiac catheterization,echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels.Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter(CVC),and use of anticoagulation were recorded.RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses,of which 56(73%)had an upper extremity PICC at some point prior to this procedure.Median duration of PICC usage was 24 d(25%,75%:12,39).Seventeen patients(30%)with PICCs also had internal jugular or subclavian central venous catheters(CVCs)in place at some point prior to their superior cavopulmonary anastomoses,median duration 10 d(25%,75%:8,14).Thrombus was detected in association with 2 of the 56 PICCs(4%)and 3 of the 17 CVCs(18%).All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients.No patients developed clinically significant venous stenosis.CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheterassociated thrombosis.展开更多
文摘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 thro-mboplastin time(a PTT)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 a PTT 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(a PTT,anti-Xa or R-TEG value).CONCLUSION This study suggests that while there is strong correlation between a PTT,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.
文摘BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement.This complication is more serious among patients with single ventricle physiology,as it might preclude them from undergoing further life-sustaining palliative surgery.AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters(PICCs)in children with single ventricle physiology.METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure.Clinical data including ultrasonography,cardiac catheterization,echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels.Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter(CVC),and use of anticoagulation were recorded.RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses,of which 56(73%)had an upper extremity PICC at some point prior to this procedure.Median duration of PICC usage was 24 d(25%,75%:12,39).Seventeen patients(30%)with PICCs also had internal jugular or subclavian central venous catheters(CVCs)in place at some point prior to their superior cavopulmonary anastomoses,median duration 10 d(25%,75%:8,14).Thrombus was detected in association with 2 of the 56 PICCs(4%)and 3 of the 17 CVCs(18%).All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients.No patients developed clinically significant venous stenosis.CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheterassociated thrombosis.
