Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study

Trisha Wong, Thuan Nguyen, Samir S. Shah, Thomas V. Brogan, Char M. Witmer

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE:: To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System–participating children’s hospital. DESIGN:: Retrospective, multi-center, cohort study. SETTING:: Forty-three free-standing children’s hospitals participating in Pediatric Health Information System. SUBJECTS:: Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012. INTERVENTIONS:: Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS:: International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36–1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14–1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04–1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89–1.11; p = 0.90). CONCLUSIONS:: In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - Sep 22 2016

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Extracorporeal Membrane Oxygenation
Antithrombins
Multicenter Studies
Cohort Studies
Pediatrics
Length of Stay
Health Information Systems
Odds Ratio
Hospitalization
Mortality
International Classification of Diseases
Hospital Mortality
Multivariate Analysis
Retrospective Studies
Clinical Trials
Costs and Cost Analysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation : A Multicenter Cohort Study. / Wong, Trisha; Nguyen, Thuan; Shah, Samir S.; Brogan, Thomas V.; Witmer, Char M.

In: Pediatric Critical Care Medicine, 22.09.2016.

Research output: Contribution to journalArticle

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title = "Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study",
abstract = "OBJECTIVE:: To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System–participating children’s hospital. DESIGN:: Retrospective, multi-center, cohort study. SETTING:: Forty-three free-standing children’s hospitals participating in Pediatric Health Information System. SUBJECTS:: Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012. INTERVENTIONS:: Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS:: International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5{\%}) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4{\%} to 51.9{\%} (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95{\%} CI, 1.36–1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95{\%} CI, 1.14–1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95{\%} CI, 1.04–1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95{\%} CI, 0.89–1.11; p = 0.90). CONCLUSIONS:: In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.",
author = "Trisha Wong and Thuan Nguyen and Shah, {Samir S.} and Brogan, {Thomas V.} and Witmer, {Char M.}",
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T1 - Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation

T2 - A Multicenter Cohort Study

AU - Wong, Trisha

AU - Nguyen, Thuan

AU - Shah, Samir S.

AU - Brogan, Thomas V.

AU - Witmer, Char M.

PY - 2016/9/22

Y1 - 2016/9/22

N2 - OBJECTIVE:: To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System–participating children’s hospital. DESIGN:: Retrospective, multi-center, cohort study. SETTING:: Forty-three free-standing children’s hospitals participating in Pediatric Health Information System. SUBJECTS:: Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012. INTERVENTIONS:: Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS:: International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36–1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14–1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04–1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89–1.11; p = 0.90). CONCLUSIONS:: In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.

AB - OBJECTIVE:: To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System–participating children’s hospital. DESIGN:: Retrospective, multi-center, cohort study. SETTING:: Forty-three free-standing children’s hospitals participating in Pediatric Health Information System. SUBJECTS:: Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012. INTERVENTIONS:: Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS:: International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36–1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14–1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04–1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89–1.11; p = 0.90). CONCLUSIONS:: In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.

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