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Standard dosing regimens of 50 IU kg 12 h were insufficient to reach the target range of anti-Xa activity of 0.2 to 0.4 IU mL.
A total of 42 patients met eligibility requirements and were randomised to pre-dosing (n = 23) or standard dosing arm (n = 19).
Standard dosing consists of 0.4 mg/kg bolus followed by 0.15 mg/kg/hr and standard dosing consists of a bolus followed by an infusion and monitoring employs the APTT aiming for a range of 1.5 2.5.
Last year, the American Academy of Pediatrics endorsed moving to milliliter-only dosing, and recommended standard dosing tools.
The Food and Drug Administration in 2013 recommended that over-the-counter products use standard dosing tools and consistent labeling, but the changes were not required.
The results "provide the evidence" in favor of standard dosing, said Dr. Ian M. Paul, a professor of pediatrics at Penn State College of Medicine who was not involved in the study.
These findings need to be explored further with randomized controlled trials, outlining a standard dosing regimen.
Standard dosing also simplifies the regimen for the non-anesthetist providers for whom this training package was designed.
Consequently, standard dosing may result in drug plasma concentrations that are subtherapeutic or toxic in some patients.
Conclusion: In children with ECMO, unfractionated heparin standard dosing regimen and empirical adjustments are not appropriate to reach and maintain the target of anti-Xa activity.
However, since active SMX does not accumulate with standard dosing in dialysis patients, the optimum dosing of the combination becomes challenging.
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