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PEDIATRIC ANESTHESIA

An Evaluation of the Effects of a Standard Heparin Dose on Thrombin Inhibition During Cardiopulmonary Bypass in Neonates

Nina A. Guzzetta, MD^*, Bruce E. Miller, MD^*, Kathy Todd, RN, BA, CCRC, Fania Szlam, MMSc^*, Renee H. Moore, BS, and Steven R. Tosone, MD^*

*Department of Anesthesiology, Emory University School of Medicine; Cardiac Research Department, Children’s Healthcare of Atlanta at Egleston; Department of Biostatistics, Emory University, Atlanta, Georgia

Address correspondence to Nina A. Guzzetta, MD, Department of Anesthesiology, Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Road NE, Atlanta, GA 30322. Address e-mail to nina_guzzetta{at}emoryhealthcare.org

We compared the adequacy of heparinization in neonates and older children undergoing cardiopulmonary bypass (CPB) by measuring heparin activity, thrombin formation, and thrombin activity. Ten neonates and 10 older children were administered 400 U/kg of heparin before CPB. Heparin anti-Xa activity, prothrombin fragment 1.2 (F1.2), and fibrinopeptide A (FPA) were measured at baseline, after 30 min on CPB, immediately post-CPB, and 3 and 24 h post-CPB. Heparin anti-Xa activity was significantly decreased during and immediately post-CPB in the neonatal group. F1.2 and FPA levels in neonates were significantly higher at baseline, decreased with the commencement of CPB, and increased to levels higher than those in older children after CPB. Our data show that with standard heparin doses, neonates exhibit less heparin anti-Xa activity during CPB. Higher baseline levels of F1.2 and FPA present in neonates indicate preoperative activation of their coagulation systems as compared with older children. Although F1.2 and FPA levels initially decrease with the commencement of CPB, probably representing hemodilution, the subsequent increase in these markers indicates significantly more thrombin formation and activity during and after CPB. These results raise the concern that 400 U/kg of heparin may not adequately suppress thrombin formation and activity in neonates undergoing CPB.

This article has been cited by other articles:

				N. A. Guzzetta, T. Bajaj, T. Fazlollah, F. Szlam, E. Wilson, A. Kaiser, S. R. Tosone, and B. E. Miller A Comparison of Heparin Management Strategies in Infants Undergoing Cardiopulmonary Bypass Anesth. Analg., February 1, 2008; 106(2): 419 - 425. [Abstract] [Full Text] [PDF]

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				N. A. Guzzetta, B. E. Miller, K. Todd, F. Szlam, R. H. Moore, K. K. Brosius, E. C. Wilson, A. M. Cohen, and S. R. Tosone Clinical Measures of Heparin's Effect and Thrombin Inhibitor Levels in Pediatric Patients with Congenital Heart Disease Anesth. Analg., November 1, 2006; 103(5): 1131 - 1138. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999