Berlin Heart EXCOR Pediatric VAD, Manual, Page: 157 / 250

NOTICE
Chapter 12 Anticoagulation therapy
If during standard unfractionated heparin therapy:
1. Platelet count is < 40,000/µl revert to the Stage I heparin dose for
continuous infusion (see Tab. 12-1, page 150)
2. Platelets <20,000/ul discontinue heparin and consider evaluation for
heparin induced thrombocytopenia (HIT).
If the anti factor Xa or PTT is too low or too high during heparin therapy,
never use a bolus of heparin or protamine. Instead, increase or
decrease the heparin dose, IU/hour, as required (see Tab. 12-1,
page 150).
12.3.5 Thrombelastography (TEG
®
)
TEG ® analysis may be useful in managing the anticoagulation and anti-platelet
therapy. Please contact Berlin Heart Inc., Clinical Affairs for further information.
12.4 Low Molecular Weight Heparin
At 48 hours following surgery if all bleeding has stopped, the creatinine is within
normal limits, and the patient is hemodynamically stable, switching from
unfractionated heparin to low molecular weight heparin (LMWH) is recommended.
• Patient < 3 months start administration of Enoxaparin at 1.8 mg/kg
subcutaneously every 12 hours.
• Patient > 3 - 12 months start administration of Enoxaparin at 1.4 mg/kg
subcutaneously every 12 hours.
• Patient > 1 – 5 years start administration of Enoxaparin at 1.2 mg/kg
subcutaneously every 12 hours.
• Patient > 5 – 16 years start administration of Enoxaparin at 1.1 mg/kg
subcutaneously every 12 hours.
• Stop heparin infusion and administer LMWH (subcutaneously) simultaneously.
• Obtain the first anti factor Xa level at 4 hours after the 2nd LMWH dose is
administered. See Tab. 12-2, page 150 for monitoring and dosing.
• Anti factor Xa therapeutic range: 0.6 to 1.0 U/ml.
• Anti factor Xa should be monitored along with platelet count, and creatinine
• When using LMWH, monitor Anti factor Xa daily. Once the Anti Factor Xa level is
in the therapeutic range at a stable dose, monitor twice a week for 2 weeks, and
then weekly.
12.5 Oral Anticoagulation Therapy (only for patients ≥ 12
months of age who are taking a full oral diet)
ADVICE
This section only applies to patients ≥ 12 months. Oral anticoagulation
in children < 12 months of age is not recommended due to difficulties
with monitoring the warfarin effect.
When the patient's condition has been fully stabilized (e.g. hemodynamically stable,
no evidence of bleeding, etc), switch to oral anti-coagulation therapy with a vitamin K
antagonist (target INR: 2.7 to 3.5), with an initial loading dose of 0.2 mg/kg/day. Do not
exceed maximum loading dose of 5mg/day. The INR must be checked daily in the first
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