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Abstract

Introduction: Because of differing pharmacokinetic properties of the available AT concentrate products, concerns have arisen related to potential differences in therapeutic efficacy and dosing requirement resulting in increased costs. Methods: A retrospective, observational study was conducted to evaluate AT replacement in Pediatric ICU patients who were anticoagulated with unfractionated heparin or enoxaparin and received hAT or rAT. Patients that received AT for reasons other than optimizing anticoagulation were excluded. Nine months of utilization of each medication were reviewed via medical records. The primary outcome was time to therapeutic anti-Xa level. Secondary outcomes included number of doses required and cost of AT therapy. A subgroup analysis was performed based on extracorporeal membrane oxygenation (ECMO) status. Results: One hundred three treatment events in 28 patients were included. A therapeutic anti-Xa level post-AT dose was observed in 82.4% (14/17) of hAT events and 53.5% (46/86) of rAT events. Of the 60 events evaluated for time to achieve a therapeutic anti-Xa level, both groups demonstrated similar times [hAT 6.2 hours vs rAT 4.1 hours; p=0.19]. When time to therapeutic anti-Xa was evaluated for ECMO versus non-ECMO events, the hAT ECMO (n=2) and hAT non-ECMO (n=12) groups achieved therapeutic levels in 9.8 hours and 5.38 hours (p=0.38), respectively. No difference in time to therapeutic level was observed in rAT ECMO and rAT non-ECMO groups [3.4 (n=10) vs 4.6 (n=36); p=0.69]. Median number of AT doses utilized per patient were similar between hAT (N=8) and rAT (N=20) groups (3 vs 2; p=0.379). Median cost per patient of AT replacement therapy based on average wholesale price was different between hAT and rAT ($2209 vs $936; p<0.001). Conclusions: These findings suggest hAT and rAT products for AT replacement have a similar time to therapeutic anticoagulation in critically ill pediatric patients. Results also demonstrate that AT product costs in this setting may be less with rAT.