P0348 / #1857: ANTICOAGULATION IN PAEDIATRIC CARDIAC PATIENTS: EVIDENCE BASED OR HISTORICAL ART?

Abstract

Aims & Objectives: Introduction Peri-operative paediatric cardiac patients frequently require anticoagulation therapy. Cardiac surgery is associated with abnormal post-operative bleeding and thrombosis events. The ACCP published recommendations in 2012, however there remains no consensus on which cardiac patients require what anticoagulation. Standardisation of anticoagulation minimises variability and errors whilst improving patient safety. Objective To update anticoagulation protocol for cardiac patients at Bristol Royal Hospital for Children based on national consensus and analyse compliance with new guideline. Methods: The anticoagulation guidelines of 10 UK paediatric cardiac centres were collected and compared. Our local guideline was updated based on best practice nationally and introduced in January 2020. Anticoagulation management of all patients admitted to PICU following cardiac surgery was analysed during subsequent 5 months to determine standard of documentation and clinical reasons for deviation in treatment. Results: There was equipoise in guidelines regarding anticoagulation and therapeutic monitoring nationally. Following introduction of our guideline, 95 patients were identified for analysis who were admitted to PICU between January and May 2020. The average age was 2 years and 3 months (range: day 1 of life to 16 years). On admission to PICU, 85% had documentation of an anticoagulation plan. The initial and long-term anticoagulation therapy corresponded to the guideline in 63% and 52% of patients, respectively. Reasons to deviate from the guideline were documented in 20% and 11% cases, respectively. Conclusions: There is no UK consensus on anticoagulation guidance for paediatric cardiac patients. Introduction of amalgamated new guidelines resulted in improved standardisation and documentation.