Evaluation of acquired antithrombin deficiency in paediatric patients supported on extracorporeal membrane oxygenation

David E. Procaccini, Jennifer Roem, Derek K. Ng, Thomas E. Rappold, Dawoon Jung, Jogarao V.S. Gobburu, Melania M. Bembea

Research output: Contribution to journalArticlepeer-review


Aims: There remains a paucity of literature regarding best practice for antithrombin (AT) monitoring, dosing and dose–response in paediatric extracorporeal membrane oxygenation (ECMO) patients. Methods: We conducted a retrospective cohort study at a quaternary care paediatric intensive care unit in all patients <18 years of age supported on ECMO from 1 June 2011 to 30 April 2020. Adverse events and outcomes were characterized for all ECMO runs. AT activity and replacement were characterized and compared between two clinical protocols. AT activities measured post- vs. pre-AT replacement were compared in order to characterize a dose–response relationship. Results: The final cohort included 191 patients with 201 ECMO runs and 2028 AT activity measurements. The median AT activity was 65% (interquartile range [IQR], 51–82) and 879 (43.3%) measurements met the criteria of deficient. The overall median AT dose and increase in AT activity were 50.6 units/kg/dose (IQR, 39.5–67.2) and 23.5% (IQR, 9.8–36.0), respectively. In the protocol that restricted AT activity measurements to clinical scenarios concerning for heparin resistance, there was significantly higher dosing in conjunction with significantly fewer overall administrations. Approximately one third of AT activity remained deficient after repletion. There was no difference in mechanical complications, reasons for discontinuation of ECMO support, time on ECMO or survival between protocols. Conclusions: There was a high prevalence of AT deficiency in paediatric ECMO patients. An AT replacement protocol based on evaluating heparin resistance is associated with fewer AT administrations, with similar circuit and patient outcomes. Further data are needed to identify optimal dosing strategies.

Original languageEnglish (US)
Pages (from-to)2396-2406
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Issue number8
StatePublished - Aug 2023


  • antithrombin
  • extracorporeal membrane oxygenation
  • heparin
  • paediatric

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology


Dive into the research topics of 'Evaluation of acquired antithrombin deficiency in paediatric patients supported on extracorporeal membrane oxygenation'. Together they form a unique fingerprint.

Cite this