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Antithrombin III Supplementation on Extracorporeal Membrane Oxygenation: Impact on Heparin Dose and Circuit Life

Byrnes, Jonathan W.*†; Swearingen, Christopher J.; Prodhan, Parthak*†; Fiser, Richard*; Dyamenahalli, Umesh

doi: 10.1097/MAT.0000000000000010
Pediatric Circulatory Support

Antithrombin III (ATIII) is used during extracorporeal membrane oxygenation (ECMO) based on physiologic rationale and studies during cardiopulmonary bypass. In February 2008, our institution began using ATIII as replacement for low ATIII activity (<70%) in patients supported with ECMO. We hypothesized that ATIII supplementation would reduce heparin infusion rates, increase unfractionated heparin anti-Xa levels, and prolong ECMO circuit life. Data from 40 consecutive patients (45 deployments) requiring ECMO support for >72 hours with venoarterial ECMO from January 1, 2007, through December 31, 2008, were collected. Antithrombin III concentrate was administered for ATIII activity <70% at the discretion of the attending physician. The primary outcome was whether the heparin infusion rate was reduced by 10% or more as a result of ATIII administration. No difference in heparin infusion rate (p = 0.245) as a result of ATIII administration was observed. Anti-Xa levels were lower before ATIII administration (p< 0.001) and were increased after ATIII administration (p < 0.001). There was an increased frequency of circuit failure in ATIII treatment group compared with nontreatment group (p = 0.018). Neither heparin responsiveness nor circuit life was enhanced by daily ATIII supplementation for activity <70%. Future studies are warranted to evaluate the effectiveness of antithrombin replacement.

From the *Department of Pediatrics, Section of Critical Care, University of Arkansas Medical, Sciences, Little Rock, Arkansas; Department of Pediatrics, Section of Cardiology, University of Arkansas Medical, Sciences, Little Rock, Arkansas; and Department of Pediatrics, Section of Biostatistics, University of Arkansas Medical Sciences, Little Rock, Arkansas.

Submitted for consideration May 2013; accepted for publication in revised form August 2013.

Disclosure: The authors have no conflicts of interest to report.

Reprint Requests: Jonathan W. Byrnes, Cincinnati Children’s Hospital, MLC2003, 3333 Burnett Ave, Cincinnati, OH 45229. Email:

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