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Lack of correlation between heparin dose and standard clinical monitoring tests in treatment with unfractionated heparin in critically III children

From the Division of Hematology/Oncology (SK); Departments of Critical Care Medicine & Anesthesia (PE, BJ); Department of Population Health Sciences, The Hospital for Sick Children, University of Toronto, Toronto (PV, AL, LGM); Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Canada (PM LGM).

Correspondence: Lesley Mitchell, Stollery Children’s Hospital, Dept of Pediatrics, Pediatric Thrombosis Program, Dentistry Pharmacy Centre, Rm 1130, 11304-89 Avenue, Edmonton, AB T6G 2C7, Canada. E-mail: lesleymitchell{at}cha.ab.ca

The activated partial thromboplastin time (aPTT) and anti-Xa activity are used for monitoring unfractionated heparin (UFH) therapy in children and may not be optimal. Objective: Determine correlations of aPTT, anti-Xa and UFH dose in children. Single centre prospective cohort study in children receiving UFH. The aPTT and anti-Xa results from routine coagulation monitoring were collected. Thirty-nine children (median age 18 days) were enrolled. There was no relationship between aPTT and UFH dose (r²=0.12) or anti-Xa and UFH dose (r²=0.03) or aPTT and anti-Xa (r²=0.22). aPTT and anti-Xa do not accurately monitor UFH therapy in children.

Key words: unfractionated heparin, children, monitoring.