A clinical audit of antithrombin concentrate use in a tertiary paediatric centre

Authors

  • Christina Kozul,

    1. Haematology Research Group, Murdoch Childrens Research Institute
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  • Fiona Newall,

    1. Haematology Research Group, Murdoch Childrens Research Institute
    2. Department of Clinical Haematology, Royal Children's Hospital
    3. Departments of Paediatrics
    4. Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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  • Paul Monagle,

    1. Haematology Research Group, Murdoch Childrens Research Institute
    2. Department of Clinical Haematology, Royal Children's Hospital
    3. Departments of Paediatrics
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  • Eliza Mertyn,

    1. Haematology Research Group, Murdoch Childrens Research Institute
    2. Department of Clinical Haematology, Royal Children's Hospital
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  • Vera Ignjatovic

    Corresponding author
    1. Haematology Research Group, Murdoch Childrens Research Institute
    2. Department of Clinical Haematology, Royal Children's Hospital
    3. Departments of Paediatrics
      Dr Vera Ignjatovic, Head of Laboratory Research, Haematology Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +61 3 9349 1819; email: verai@unimelb.edu.au
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Dr Vera Ignjatovic, Head of Laboratory Research, Haematology Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +61 3 9349 1819; email: verai@unimelb.edu.au

Abstract

Aim:  The aim of this study was to investigate the clinical use of antithrombin concentrate (ATC) in children and specifically to determine the current practice of ATC administration, including dosing and indications for administration.

Methods:  A clinical audit was performed of patients treated with ATC during two 12-month periods: 1 June 1999–1 June 2000 and 1 June 2009–1 June 2010.

Results:  Thirty-seven patients whose age ranged from 1 day to 13.5 years (median 30 days) received a median of two doses (range 1–15) with a median dose of 40 units/kg (range 1–200 units). The majority (90%) of patients were located in the intensive care unit, and the major indication (76%) for use of the ATC was in the setting of unfractionated heparin (UFH) resistance. Post-ATC administration, 32% of the doses given resulted in antithrombin levels reaching age-specific normative levels. Of the patients administered ATC with the aim of optimising UFH therapy, 28% of patients had their UFH dose reduced without any measurement of UFH effect.

Conclusions:  This data provides the basis for future investigations of the specific biochemical changes accompanying ATC administration and the development of paediatric-specific evidence-based guidelines for ATC use.

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