• Edmund H Jooste, Rebecca Scholl, Yi-Hung Wu, Jaquiss Robert D B RDB Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center and Children's Medical Center, Dallas, TX., Andrew J Lodge, Warwick A Ames, H Mayumi Homi, Kelly A Machovec, Nathaniel H Greene, Brian S Donahue, Nirmish Shah, and Claudia Benkwitz.
• Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: edmund.jooste@dm.duke.edu.
• J. Cardiothorac. Vasc. Anesth. 2019 Feb 1; 33 (2): 396-402.

ObjectivesTo determine whether precardiopulmonary bypass (CPB) normalization of antithrombin levels in infants to 100% improves heparin sensitivity and anticoagulation during CPB and has beneficial effects into the postoperative period.DesignRandomized, double-blinded, placebo-controlled prospective study.SettingMulticenter study performed in 2 academic hospitals.ParticipantsThe study comprised 40 infants younger than 7 months with preoperative antithrombin levels <70% undergoing CPB surgery.InterventionsAntithrombin levels were increased with exogenous antithrombin to 100% functional level intraoperatively before surgical incision.Measurements And Main ResultsDemographics, clinical variables, and blood samples were collected up to postoperative day 4. Higher first post-heparin activated clotting times (sec) were observed in the antithrombin group despite similar initial heparin dosing. There was an increase in heparin sensitivity in the antithrombin group. There was significantly lower 24-hour chest tube output (mL/kg) in the antithrombin group and lower overall blood product unit exposures in the antithrombin group as a whole. Functional antithrombin levels (%) were significantly higher in the treatment group versus placebo group until postoperative day 2. D-dimer was significantly lower in the antithrombin group than in the placebo group on postoperative day 4.ConclusionSupplementation of antithrombin in infants with low antithrombin levels improves heparin sensitivity and anticoagulation during CPB without increased rates of bleeding or adverse events. Beneficial effects may be seen into the postoperative period, reflected by significantly less postoperative bleeding and exposure to blood products and reduced generation of D-dimers.Copyright © 2018 Elsevier Inc. All rights reserved.

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