Berlin Heart EXCOR Pediatric VAD, Manual, Page: 156 / 250

Chapter 12 Anticoagulation therapy
Approximately 24 - 48 hours after implantation, commence unfractionated heparin
therapy (i.v.) if the following criteria are met:
• Platelet count >20,000/µl
• Normal Platelet Function Studies
• Minimal bleeding in infants and young children.
12.3.3 Unfractionated heparin therapy (i.v.) Patient < 12 months
• Initial dose 15 IU/kg/hour.
• Do not use a bolus
• After 6 hours if the patient does not have increased bleeding, increase the
heparin infusion to 28 IU/kg/hour (therapeutic dose).
6 hours after increasing the heparin to the therapeutic dose, obtain a PTT and an
antifactor Xa level.
If the anti factor Xa level is desired range (0.35-0.5 U/ml) and the PTT is in the
therapeutic range (institution dependent), then either the PTT or anti factor Xa level
may be used to follow the heparin therapy.
If the anti factor Xa level is <0.35 U/ml or >0.5 U/ml, increase or decrease the heparin
infusion, respectively until the anti factor Xa level is the therapeutic range (see
Tab. 12-1, page 150).
Anti factor Xa levels should be obtained daily. IMPORTANT: hyperbilirubinemia may
result in falsely low anti factor Xa levels. If anti Xa levels do not correlate with the PTT
in this setting, consider using the PTT to monitor heparin therapy.
Antithrombin should be >70%. If the antithrombin is <70%, treat according to
institutional protocol.
12.3.4 Unfractionated heparin therapy (i.v.) Patient ≥ 12 months
Initial dose 10 IU/kg/hour.
Do not use a bolus.
After 6 hours if the patient does not have increased bleeding, increase the heparin
infusion to 20 IU/kg/hour (therapeutic dose).
6 hours after increasing the heparin to the therapeutic dose, obtain a PTT and an anti
factor Xa level.
If the anti factor Xa level is desired range (0.35-0.5 U/ml) and the PTT is in the
therapeutic range (institution dependent), then either the PTT or anti factor Xa level
may be used to follow the heparin therapy.
If the anti factor Xa level is < 0.35 U/ml or > 0.5 U/ml, increase or decrease the heparin
infusion, respectively until the anti factor Xa level is the therapeutic range (see
Tab. 12-1, page 150).
Anti factor Xa levels should be obtained daily. IMPORTANT: hyperbilirubinemia may
result in falsely low anti factor Xa levels. If anti Xa levels do not correlate with PTT in
this setting, consider using the PTT to monitor heparin therapy.
Antithrombin should be >70%. If the antithrombin is <70%, treat according to
institutional protocol.
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