Age-related differences in heparin response

Ignjatović, Vera; Furmedge, Janine; Newall, Fiona; Chan, Anthony; Berry, Leslie R.; Fong, Chrystal; Cheng, Ken Chih-Chien; Monagle, Paul

doi:10.1016/j.thromres.2005.11.004

Cited by 98 publications

(96 citation statements)

References 17 publications

(17 reference statements)

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“…The correlation between APTT and heparin effect as measured by anti-FXa and protamine titration was, however, relatively weak (anti-FXa r 2 = 0AE51, protamine = 0AE55) (Andrew et al, 1994b). More recent in vitro, ex vivo and in vivo studies have, however, demonstrated a lack of correlation between the two assays together with an age-dependent heparin effect (Ignjatovic et al, 2006;Kuhle et al, 2007b;Chan et al, 2008;Newall et al, 2009a). Chan et al (2008) found the APTT to be least predictive of the anti-FXa effect in children under 2 years, the correlation was greater in older children .…”

Section: Monitoring Ufhmentioning

confidence: 96%

“…Pharmacokinetic and pharmacodynamic responses to anticoagulants are also age-dependent (McDonald et al, 1981;Massicotte et al, 1996;Streif et al, 1999;Kuhle et al, 2005;Ignjatovic et al, 2006). Understanding the changing quantitative and qualitative aspects of haemostasis is crucial for those needing to risk stratify, diagnose and optimally manage thromboses in children.…”

Section: Considerations In Children (Fig 1)mentioning

confidence: 99%

“…The same study found a trend to lower anti-FXa and anti-FIIa activity in younger children but this is in contrast to in vitro studies that have found greater anti-FIIa effects. Variations in the anti-FIIa to FXa effect across ages may be one determinant of agedependent dosing and also has implications for monitoring therapy (Ignjatovic et al, 2006).…”

Section: Unfractionated Heparinmentioning

confidence: 99%

“…Ignjatovic et al (2006) reported APTTs >180 s in association with anti-FXa results in the therapeutic range in 10/27 children <1 year, 15/23 1-5 years and 3/8 of those 6-10 years (Ignjatovic et al, 2006). Newall et al (2009b) also demonstrated a high proportion of children with very high APTTs after a 75-100 iu/kg UFH bolus (mean APTT 586 s (95% CI 394-778) at 15 min post-bolus and 250 s (95% CI 200-300) at 120 min) with correspondingly high anti-FXa levels initially [mean 0AE88 (95% CI 0AE84-0AE91)] and therapeutic levels at the later time point [mean 0AE63 (95% CI 0AE58-0AE68] (Newall et al, 2009b).…”

Section: Monitoring Ufhmentioning

confidence: 99%

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Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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Section: Monitoring Ufhmentioning

confidence: 96%

Section: Considerations In Children (Fig 1)mentioning

confidence: 99%

Section: Unfractionated Heparinmentioning

confidence: 99%

Section: Monitoring Ufhmentioning

confidence: 99%

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Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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“…Recent in vitro and in vivo data also indicate that the aPTT range that correlates to an anti-Xa level of 0.35 to 0.7 units/mL varies signifi cantly with age and heparin dose. 5,27,[35][36][37]40 Further, protamine titration results vary with age, 5 and different commercial anti-Xa kits can give substantially different results for anti-Xa measurements on the same samples probably because of subtle differences in kit formulation. This effect is seen in both adults and children.…”

Section: 57mentioning

confidence: 99%