Supplemental Use of Antithrombin Ill Concentrate in the Pediatric Patient

Abstract

Decreased AT-III levels during cardiopulmonary bypass (CPB) have been observed in pediatric patients and are attributable to hemodilution. Prebypass administration of AT-III to the pediatric patient has been shown to prevent decreases in serum AT-III levels and elevated fibrinopeptide A (FPA) levels before and after bypass. We compared the clinical outcome of patients receiving supplemental AT-III injectate to control patients. Patients with preoperative AT-III levels less than 80% received AT-III injectate prior to heparinization. A retrospective analysis of 149 patients (31 study patients vs. 118 controls) revealed that a greater percentage of patients receiving AT-III were cyanotic (p=0.001) and underwent more complex cardiac repairs (p=0.001). Compared to patients not receiving AT-III, surgeries were performed at lower temperatures (p=0.040) with longer CPB times (p=0.031) and circulatory arrest times (p=0.047). Baseline AT-III levels were significantly lower in the treated group (p<0.0001) but were significantly higher during CPB (p=0.0001). Total postoperative blood loss, blood product administration, rate of reoperation, total time in ICU and mortality proved not to be significantly different between the groups after adjusting for above covariates (p=NS). It appears that maintenance of higher AT-III levels did not affect the clinically measurable outcome variables associated with hemostasis.