Abstract：
Critically ill pediatric patients supported on ventricular assist devices (VADs) are increasingly being anticoagulated on bivalirudin, but with difficulty monitoring anticoagulation. Activated partial thromboplastin time (aPTT) has recently been shown to poorly correlate with bivalirudin plasma concentrations, while dTT had excellent correlation. However, aPTT is the more common monitoring test and dTT testing is rarely used. In addition, effects of frequent clinical VAD scenarios (such as inflammation) on the accuracy of aPTT and dTT testing remains uncertain. We reviewed the effects of clinical scenarios (infection/inflammation, chylothorax, and steroids administration) on anticoagulation monitoring in 10 pediatric VAD patients less than 3 years at Cincinnati Children\'s Hospital Medical Center from 10/27/2020 to 5/6/2022 using bivalirudin for anticoagulation. There were 16 inflammation/infection, 3 chylothorax, and 6 steroids events. Correlation between dTT and aPTT was significantly lower after infection/inflammation, with dTT increasing prior to inflammation/infection while aPTT remained unchanged. In addition, steroids are administered to VAD patients to reduce inflammation and thus additionally stabilize anticoagulation. However, this anticoagulation stabilization effect was reflected more accurately by dTT compared to aPTT. In children requiring VAD support utilizing bivalirudin anticoagulation, inflammation/infection is a common occurrence resulting in anticoagulation changes that may be more accurately reflected by dTT as opposed to aPTT.
摘要：
在心室辅助装置（VAD）支持下的重症儿科患者越来越多地接受比伐卢定的抗凝治疗，但难以监测抗凝。激活部分凝血活酶时间（aPTT）最近已被证明与比伐卢定血浆浓度相关性差。而DTT有很好的相关性。然而,aPTT是更常见的监测测试和dTT测试很少使用。此外,频繁的临床VAD方案(如炎症)对aPTT和dTT检测准确性的影响仍不确定.我们回顾了临床情景的影响(感染/炎症，乳糜胸,和类固醇给药）在2020年10月27日至2022年5月6日在辛辛那提儿童医院医疗中心使用比伐卢定进行抗凝治疗的10名小于3年的小儿VAD患者中进行抗凝监测。有16种炎症/感染，3乳糜胸，和6个类固醇事件。感染/炎症后dTT和aPTT的相关性明显降低，dTT在炎症/感染前增加，而aPTT保持不变。此外,向VAD患者施用类固醇以减轻炎症,从而额外稳定抗凝.然而,与aPTT相比,dTT更准确地反映了这种抗凝稳定作用.在需要使用比伐卢定抗凝治疗的VAD支持的儿童中，炎症/感染是导致抗凝改变的常见病,其可以通过dTT而不是aPTT更准确地反映。
