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PO-0289 It Takes More Than Eight Days Before Tinzaparin Leads To Adequate Anti-xa Levels In Paediatric Intensive Care Patients Following Congenital Heart Surgery
  1. A van der Hoeven1,
  2. PP Roeleveld1,
  3. R de Wilde2,
  4. HE Bunker-Wiersma1
  1. 1Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
  2. 2Intensive Care, Leiden University Medical Center, Leiden, Netherlands

Abstract

Objective Tinzaparine is used in paediatric intensive care (PICU) following cardiac surgery as a bridge to oral anticoagulation. Low Molecular Weight Heparins (LMWH), such as Tinzaparin are thought to lead to immediate anticoagulation with adequate anti-Xa levels 2–4 hours after the first dose. Dosing following international guidelines, is age dependent and guided by anti-Xa levels. However, little is known about LMWH dosing in PICU patients. We conducted a retrospective study to evaluate tinzaparin dosing.

Methods We retrospectively analysed Tinzaparin doses and anti-Xa levels from all children admitted to PICU (January 2012–December 2013). Hospital policy is to determine the first aXa level after 3–4 doses and 4 h post dose, targeting 0.5–1.5 IU/ml.

Results There were 31 episodes of newly started Tinzaparin in 28 children. Mean age was 57 (SD±62) months. First anti-Xa levels were determined at 3.45 (SD±1.9; range 1–12) days after the first dose and were sub therapeutic in 25 of 31 (81%): mean 0.33 (SD± 0.15) IU/ml. Tinzarin dose was increased in 12/25 (48%) patients and further anti-Xa levels were determined. In 15 patients further levels were not available due to transition to vit K antagonists or PICU discharge. Therapeutic anti-Xa levels (0.69 (SD± 0.27) IU/ml), were eventually reached in PICU in 16 patients after a mean of 8.8 (SD± 7.1 range 3–30) days.

Conclusion Tinzaparin dosing in PICU patients only leads to target anti-Xa levels after more than 8 days. Levels need to be determined after the first dose so that doses can be adequately increased.

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