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...

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Bibliographic Details
Published in:Journal of pediatric surgery 2017-04, Vol.52 (4), p.609-613
Main Authors: Stansfield, Brian K, Wise, Linda, Ham, P. Benson, Patel, Pinkal, Parman, Malinda, Jin, Chan, Mathur, Sunil, Harshfield, Gregory, Bhatia, Jatinder
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
Antithrombin III
Antithrombin III - therapeutic use
Bleeding
Blood Coagulation Tests
Blood Transfusion
Coagulation
ECMO
Extracorporeal Membrane Oxygenation - adverse effects
Female
Hemorrhage - diagnosis
Hemorrhage - etiology
Hemorrhage - prevention & control
Hemorrhage - therapy
Heparin - therapeutic use
Humans
Infant, Newborn
Male
Neonatal
Pediatrics
Respiratory Insufficiency - therapy
Retrospective Studies
Surgery
Thrombosis
Thrombosis - diagnosis
Thrombosis - etiology
Thrombosis - prevention & control
Time Factors
Treatment Outcome
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Summary: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 anti-coagulation therapy. Total blood product infusion during ECMO was decreased (54.7 ± 20.1 vs. 67.4 ± 34.9 ml/kg/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. Level of Evidence Level III
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2016.10.047