Doğumsal Kalp Hastalıklı Çocuklarda Kalp Kateterizasyonu Sırasında Aktive Edilmiş Pıhtılaşma Zamanı Testi ile 100 IU/Kg Fraksiyone Olmayan Heparin Yükleme Dozunun Yeterliliğinin Araştırılması

Amaç: Çalışmanın amacı pediatrik kalp kateterizasyonu sırasında konjenital kalp hastalığı (CHD) olan hastalarda 100 IU/kg fraksiyone olmayan heparin (UHF) yükleme dozunun 200-300 saniye aralığında aktif pıhtılaşma zamanı (ACT) değerine ulaşılabilirliğin araştırılmasıdır. Gereç ve Yöntemler: Ocak 2022 ve Mart 2023 tarihleri arasında kardiyak kateterizasyon yapılan 0-18 yaş arası CHD’li 264 hasta çalışmaya alındı. Hasta özellikleri, UHF dozları ve ACT değerleri retrospektif olarak elde edildi. Kılıf yerleştirildikten sonra hastalara 100 IU/kg intravenöz UFH yükleme yapıldı. 5. dakikadaki ACT değerinin 200 ve 300 saniye aralığında olması hedeflendi. 5. dakikada ölçülen ACT değeri <200 saniye ise toplam heparin yükleme dozu 150 IU/kg'ı geçmeyecek şekilde 20-50 IU/kg ek UFH yükleme dozları yapıldı. Hastalar ACT değerlerinin 200 saniye altı ve üstünde olmasına göre iki gruba ayrıldı. Bulgular: İşlem sırasında medyan yaş, ağırlık ve 5. dakikadaki ACT değeri sırasıyla 6.41(interquartile range (IQR): 2.01–32.21) ay, 6.13(IQR: 3.79-11.9) kg ve 212(IQR: 190-240) saniye belirlendi. 264 hastanın 170'inde (%64,4) ACT değeri hedef değer olarak kabul edilen 200-300 saniye aralığında ölçüldü. 264 hastanın 86'sında (%32,6) ACT değeri hedef değerin (<200 sn) altında ve sekiz (%3) hastada ise hedef değerin (>300 sn) üzerinde ölçüldü. Dört hastada (%1,5) giriş yerinde hematom belirlendi. Retroperitoneal hematom, kanama ve tromboembolizm hiçbir hastada belirlenmedi. Yaş alt grupları ile ACT dağılımı ve yaş alt grupları ile ACT alt grupları arasındaki karşılaştırmalarda gruplar arasında anlamlı fark belirlenmedi (p>0,05). Sonuç: Bu çalışma, kardiyak kateterizasyon sırasında 100 IU/kg UFH yükleme dozunun CHD’lı hastaların %64,4'ünde hedef ACT değer aralığını sağlayabildiğini ve geri kalan hastalarda UFH yükleme dozunun 5. dakikada ölçülen ACT değerine göre ek UHF dozları ile bireyselleştirilmesi gerektiğini gösterdi.

Anahtar Kelimeler:

Konjenital kalp hastalığı, Kalp kateterizasyonu, Fraksiyone olmayan heparin, Aktif pıhtılaşma zamanı

Investigation of the Adequacy of 100 IU/Kg Unfractionated Heparin Loading Dose by Activated Clotting Time In Children With Congenital Heart Disease During Cardiac Catheterization

Purpose: This study investigated whether an activated clotting time (ACT) between 200 and 300 sec could be achieved with a100 IU/kg unfractionated heparin (UHF) loading dose in patients with congenital heart disease (CHD) during pediatric cardiac catheterization. Materials and Methods: We included 264 patients aged 0-18 years with CHD undergoing cardiac catheterization between January 2022-March 2023. Data on patient characteristics, UHF doses, and ACT values were retrospectively obtained. The patients were intravenously administered 100 IU/kg UFH after sheath placement. We aimed to obtain a value between 200 and 300 sec according to the ACT measured at the 5th minute. If the measured ACT value at the 5th min was < 200 sec, additional heparin doses between 20 and 50 IU/kg were administered such that the total heparin loading dose did not exceed 150 IU/kg. Patients were divided into two groups based on whether the ACT value was below or above 200 sec. Results: Median age, weight, and ACT value at procedure were 6.41(IQR:2.01–32.21) months, 6.13(IQR:3.79-11.9) kg, and 212(IQR:190-240) sec, respectively. The ACT value of 170(64.4%) of the 264 patients was between 200-300 sec, which was considered the target value. The ACT value of 86(32.6%) of the 264 patients was below the target value and that of eight (3%) patients was above the target value. Hematoma occurred at the access site in four patients (1.5%). We did not detect retroperitoneal hematoma, other bleedings at location, or thromboembolism in any of the patients. No significant differences were observed in comparisons between age subgroups and ACT distribution, or between age subgroups and ACT subgroups (p>0.05) Conclusion: This study revealed that a 100 IU/kg UFH loading dose produced the target ACT value in 64.4% of the patients and that the UFH loading dose should be individualized according to the ACT value in the remaining patients.

Keywords:

Congenital heart disease , Cardiac catheterization, Unfractionated heparin, Activated clotting time,

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