Abstract
Thromboses related to umbilical artery catheters (UA caths) contribute significant morbidity to neonatal intensive support. This prospective randomized study was begun to evaluate the efficacy of prophylactic heparinization in the prevention of UA cath related thrombi. To date, 19 preterm infants have been assigned to 1) therapeutic heparinization (20-25U/kg/hr) or 2) infusions of 1-2U/ml heparin (controls). Using 10MHz ultrasound (US) thrombi of 1-18 mm were imaged 1-7 days after insertion of a UA cath. Pulsed doppler velocity in the catheterized iliac was twice that of the uncatheterized iliac and increased to ≥3/1 one to four days prior to the appearance of a thrombus on US. Aortography was performed to corroborate US and doppler findings. With these studies, thrombi were detected in 1/11 heparinized and 4/8 control infants (p <0.05). Heparinization resulted in a x̄ Laidlaw clotting time of 153 sec (N=100) and heparin levels of 0.2-0.6U/ml without complications including ICH. Baseline protein C (pro C) levels were similar in each group and lower than in term newborns (0.25 vs 0.32U/ml). By day 6, no effect of heparin was noted on levels of AT-III (0.38 vs 0.37U/ml) or pro C (0.36 vs 0.37U/ml), while platelet counts were higher in heparinized infants (247 vs 164 × 109/1). The heparinized infants had lower blood velocities in the catheterized iliac artery (48 vs 95 cm/sec on day 6). Therapeutic heparinization inhibits thrombus propagation along UA catheters resulting in less obstruction to blood flow.
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McDonald, M., Johnson, M., Rumack, C. et al. HEPARIN PREVENTION OF CATHETER RELATED THROMBOSES. Pediatr Res 18 (Suppl 4), 335 (1984). https://doi.org/10.1203/00006450-198404001-01450
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DOI: https://doi.org/10.1203/00006450-198404001-01450