An evidence-based standardized protocol for anticoagulation following congenital heart surgery

Unfractionated heparin is the cornerstone of prevention and treatment of thrombosis in children undergoing cardiac surgery due to its short half-life and reversibility using protamine. Yet, optimal titration in children remains challenging (1). Age-related differences in heparin clearance (2), protein binding activity (3,4) and anti-thrombin concentration (5-8), which are most pronounced in neonates and young infants, obscure the applicability of standard adult dosing protocols.