Heparin continuous infusion for thromboprophylaxis in pediatric liver transplant recipients.

BACKGROUND: Vascular thrombosis remains a significant cause of early graft loss and morbidity in pediatric liver transplant (PLT) patients. However, no standardized protocol for thromboprophylaxis exists. This study aimed to evaluate appropriateness of continuous infusion of unfractionated heparin (UFH) prophylaxis in PLT patients. METHODS: This retrospective study was conducted in a pediatric intensive care unit. Patients between the ages of 1 month to 14 years who received prophylactic continuous UFH infusion following PLT were included. The primary outcome was to examine the percentage of patients on intravenous continuous UFH infusion achieving the prophylactic aPTT target levels (40-60 s) in PLT recipients whereas secondary outcomes were time to target, dose titrations, thrombotic events, bleeding complications and safety outcomes. Statistical analyses were performed using Stata software, version 18. For categorical variables, frequencies and percentages were used whereas continuous data was presented as median and interquartile range (IQR). RESULTS: A total of 47 patients were included, with the majority constituting males (57.4%). Median heparin infusion duration was 55.93 h [38.97-79.97]. All patients achieved prophylactic aPTT target levels, with 89.4% reaching the target within 24 h. Median time to target achievement was 4.68 h [4.00-12.53]. Most patients (63.8%) achieved target prophylactic anticoagulation without dose titration whereas 6.4% required ≥3 titrations. Only 2 patients (4.3%) reported thrombotic complications including one portal vein thrombosis and one hepatic vein thrombosis. Clinically significant bleeding was reported in 7 patients (14.9%), with only one patient requiring surgical re-intervention. Hypotension was observed in 40.4% of patients. Median PICU length of stay was 4 days [3-6]. CONCLUSION: Postoperative thromboprophylaxis with continuous UFH infusion at an initial dose of 10 units/kg/hr was effective in achieving prophylactic anticoagulation in most PLT recipients. The protocol was associated with low thrombotic events and bleeding complications.