Plasmin generation and fibrinolysis in pediatric patients undergoing cardiopulmonary bypass surgery.

This prospective, single-centre cohort study aimed to evaluate plasmin generation and fibrinolysis during and after cardiopulmonary bypass (CPB) surgery in a cohort of children up to 6 years of age. Blood samples were drawn at eight time points: after induction of anesthesia, before unfractionated heparin (UFH), after UFH, after initiation of bypass, before protamine, after protamine, after chest closure, and 6 h after chest closure. The study identified an increase in fibrinolysis during CPB and particularly up to 6 h afterward in children.

Heparin in the long-term management of ligneous conjunctivitis: a case report and review of literature.

Ligneous conjunctivitis, secondary to inherited homozygous plasminogen deficiency, is a poorly understood condition that has the potential to hinder normal childhood development if not managed adequately. We report the clinical progression of a child with ligneous conjunctivitis, controlled with daily heparin eye drops, postsurgical excision, for a duration of approximately 5 years at a cost of approximately 30 USD per month. During this time, the patient's progress has been complicated by one occurrence of periorbital cellulitis and also otitis media.

Developmental haemostasis: secondary haemostasis.

The haemostatic system is a complex interaction between the vasculature, cellular components and plasma proteins that interact to maintain haemostasis in the healthy body. The haemostatic system can be further defined as primary, secondary and tertiary haemostasis to better define the interdependent mechanisms that combine to maintain haemostasis. The term 'developmental haemostasis' was first introduced by Maureen Andrews in the 1980s to describe the age-related physiological changes of the coagulation system as it develops progressively over time from fetal, neonatal, paediatric to adult and geriatric systems.

The quantitative and qualitative responses of platelets in pediatric patients undergoing cardiopulmonary bypass surgery.

This prospective, single-center study aimed to evaluate the platelet response during cardiopulmonary bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at four time points: after induction of anesthesia, after initiation of the CPB, before protamine, and immediately after chest closure. The study recruited 60 children requiring CPB for surgical repair of congenital heart defects.

A multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children.

Objectives: The purpose of this study was to compare the safety and efficacy of acetylsalicylic acid (ASA) and warfarin for thromboprophylaxis after the Fontan procedure.

Background: Fontan surgery is the definitive palliation for children with single-ventricle physiology. Thrombosis is an important complication; the optimal thromboprophylaxis strategy has not been determined.

Infant deaths due to heparin overdose: time for a concerted action on prevention.

Heparin is one of the most commonly used drugs in tertiary paediatric centres. Across the last decade, targeted research has been directed towards improving the level of evidence supporting paediatric-specific recommendations for the use and management of heparin in infants and children. In contrast, little effort has been directed towards improving the safe use of heparin despite a plethora of fatal and non-fatal heparin-related errors being reported in the lay press.

Effect of warfarin on menstruation and menstrual management of the adolescent on warfarin.

Aim: The aim of this study was to review a consecutive cohort of adolescent females on warfarin to determine the effect of warfarin on menstruation, management options and their perceived efficacy.

Methods: All female patients on warfarin, over the age of 10 years, as of 31 August 2006, were identified using the Department of Haematology (Royal Children's Hospital) warfarin database. The presence of menorrhagia was defined by clinical indicators.

Compliance of antithrombotic management at a tertiary paediatric hospital with international guidelines: a 100-Day audit.

Introduction: Thromboembolic disease is a growing problem in paediatric care. American College of Chest Physicians (ACCP) guidelines for antithrombotic therapy in paediatric patients provide consensus recommendations regarding appropriate antithrombotic therapy.

Materials And Methods: This study assessed antithrombotic management practices in a tertiary paediatric centre and the level of agreement of current practice with consensus guidelines across a 100-day prospective chart audit.

Bereaved parents' perceptions of the autopsy examination of their child.

Objective: In this study we explored parental views of their child's autopsy, their experiences with autopsy-related processes, and the impact of the examination on their grief.

Methods: A survey design with a mailed questionnaire was used. The inclusion criteria were that an autopsy had been performed on the child and it was at least 3 months since his or her death.

Clinical outcomes of management of CVAD occlusions.

Central venous access device (CVAD) occlusions are commonly treated with tissue plasminogen activator (tPA). Eighty-seven patients with 97 catheters at The Royal Children's Hospital, Melbourne were given tPA as per clinical practice guidelines. Restoration of CVAD patency and long-term CVAD survival were measured.

Age-related differences in plasma proteins: how plasma proteins change from neonates to adults.

The incidence of major diseases such as cardiovascular disease, thrombosis and cancer increases with age and is the major cause of mortality world-wide, with neonates and children somehow protected from such diseases of ageing. We hypothesized that there are major developmental differences in plasma proteins and that these contribute to age-related changes in the incidence of major diseases. We evaluated the human plasma proteome in healthy neonates, children and adults using the 2D-DIGE approach.

Hemostatic response in paediatric patients undergoing cardiopulmonary bypass surgery.

This prospective, single-center cohort study aimed to evaluate the hemostatic response during and after Cardiopulmonary Bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at eight time points: post-induction of anesthesia, pre-unfractionated heparin (UFH), post-UFH, post-initiation of bypass, pre-protamine, post-protamine, post-chest-closure, and 6 h post-chest-closure. As expected, all measures of the UFH effect increased significantly post-UFH bolus and decreased post-protamine administration.

Stability and sterility of diluted enoxaparin under three different storage conditions.

Aim: This study assessed whether enoxaparin sodium diluted to a concentration of 20 mg/mL for clinical use with 0.9% sodium chloride remained stable and sterile for up to 43 days under three different storage conditions.

Methods: Enoxaparin dilutions in polypropylene syringes were stored under three different controlled conditions of temperature and light: (i) room temperature (22-26°C) under natural light; (ii) room temperature (22-26°C) in the dark; and (iii) controlled refrigeration (2-8°C) in the dark.

Evidence for age-related differences in human fibrinogen.

Fibrinogen has previously been demonstrated to exist in a 'fetal' form, in cord blood of term infants, with increased sialic acid content compared to adult fibrinogen. The functional implications of these differences are reflected in prolonged thrombin clotting times in newborns as well as differences in polymerization of fibrin from 'fetal' fibrinogen. Despite numerous studies of fibrinogen structure and function, the age at which 'fetal' fibrinogen reverts to the adult form, as well as the physiological significance of this phenomenon remains unknown.

Assessing outcome measures of oral anticoagulation management in children.

The complexities of managing oral anticoagulation therapy in children have been well described and various management strategies have been designed to optimise clinical outcomes within this challenging population. To date, outcome measurements used within paediatric studies investigating oral anticoagulant management have focused upon achieving therapeutic range and examining the incidence of medication-related adverse events. Whilst the reporting of such data is a priority, the relatively small number of children participating in clinical studies of oral anticoagulant management and the difficulties associated with conducting multi-centre interventional trials in such populations limit the ability of researchers to measure the significance of interventions made.

Novel interactions between UFH and TFPI in children.

The impact of age upon therapeutic response to unfractionated heparin (UFH) in children is proposed to reflect quantitative and potentially qualitative differences in coagulation proteins across childhood. This study explores the UFH-dependent tissue factor pathway inhibitor (TFPI) release in children compared to previously published data in adults. Children <16 years of age undergoing cardiac angiography formed the population for this prospective cohort study.

Anticoagulation in neonates and children: Pitfalls and dilemmas.

Anticoagulation in children is problematic for many reasons, related to the patient population as well as the anticoagulant drugs themselves. This paper describes the multitude of reasons why providing anticoagulation therapy in children is different from anticoagulation therapy in adults, and hence why dedicated paediatric anticoagulant services are the ideal structure to provide this service. The paper then describes the three most common anticoagulants used in children, and details specifically what is and is not known about them in the paediatric population.

Clinical use of unfractionated heparin therapy in children: time for change?

Paediatric recommendations for unfractionated heparin (UFH) management are extrapolated from adult trials, a practice that may contribute to the inferior UFH-related outcomes in children compared to adults. This is the first study to determine UFH concentration in a population of children and correlated UFH concentration with measures of UFH effect. Correlation coefficients between protamine titration (concentration) and activated partial thromboplastin time (APTT), anti- activated factor X (Xa) assay and thrombin clotting time (effect) were 0·59, 0·46 and 0·52 respectively.

Placental biglycan expression is decreased in human idiopathic fetal growth restriction.

Fetal growth restriction (FGR) is a leading cause of perinatal morbidity and mortality. The majority of FGR cases are idiopathic and are associated with placental insufficiency, which can result from placental thrombosis. Evidence suggests that Dermatan Sulfate (DS) is an important anti-coagulant in placentae of uncomplicated pregnancies.

Decorin expression is decreased in human idiopathic fetal growth restriction.

Fetal growth restriction (FGR) is a clinically significant pregnancy disorder in which the fetus fails to achieve its full growth potential in utero. Most cases of FGR are idiopathic and are associated with placental thrombosis. Previous studies suggest that proteoglycans, such as decorin, that contain the glycosaminoglycan dermatan sulfate are the principal anticoagulants in the normal placenta.