Optimization of Anticoagulation Strategy During Cardiopulmonary Bypass in Neonates with Congenital Heart Disease: A Randomized Controlled Trial.
He Wang, Qindong Liu, Peng Gao et al.
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From the abstract
Neonatal hemostatic immaturity complicates anticoagulation during cardiopulmonary bypass (CPB). Current practice largely follows the strategy of 400 U/kg from adult protocols, as neonatal-specific guidelines and high-quality evidence remain lacking, which frequently fails to achieve adequate anticoagulation.
Reported results
Mean ΔF1+2 was 0.70 vs 4.08 nmol/L in the 600 and 400 U/kg groups, respectively (treatment-minus-control mean difference, -3.38 nmol/L; 95% confidence interval, -4.58 to -2.18; P <0.001). ACT target achievement rate after the initial dose was higher in the 600 U/kg group (84.2% vs 44.7%, P < 0.001).
Authors' conclusions
An initial heparin dose of 600 U/kg in neonatal CPB was associated with a smaller F1+2 increase and greater initial ACT response. Larger studies are needed to establish clinical benefit and safety.