Pre-operative management of anticoagulation therapy pathway for paediatric patients with congenital heart disease

Aortic Valve Prosthesis

Low Risk 
A standard bi-leaflet aortic valve prosthesis with no additional risk is considered low risk.

High Risk 
An increased risk of thrombosis may result from a number of factors, including:

• Previous thromboembolism
• Left ventricular dysfunction
• Hypercoagulable conditions
• Atrial fibrillation

Therapeutic low molecular weight heparin (Enoxaparin) should be administered for these situations as per the pathway for mechanical mitral valve prosthesis.

Low Molecular Weight Heparin (LMWH) For bridging to cardiac catheter/surgery

Dosing

Anti Xa level

3-4 hours post dose 
Order ‘control of heparin – child’ on trakcare 
Target range 0.5-1 i.u/ml 
Guideline for adjusting dose: Anticoagulation Therapy for Post Op Cardiac Patients in PICU 
If level sub therapeutic (low) adjust dose, re prescribe enoxaparin for current time and 12 hourly thereafter (do not wait until next dose is due).

Administration

Do not administer Enoxaparin via insuflon. 
Doses of <0.1ml in volume to be diluted up to 0.1ml with 0.9% sodium chloride

INR Level

If INR is >2 when checked on day -1, inform the consultant cardiac anaesthetist and the cardiology consultant on call, so a decision for reversal can be made. 
If reversal is appropriate:

• Seek haematology advice
• As per BNF for Children: Vitamin K 30micrograms/kg IV or oral (max 1mg) If given orally, use Konakion MM Paediatric

Dental surgery in children receiving warfarin therapy

Follow: Anti Thrombotic Protocol