Blood Coagulation Analysis in Pediatric Patients on Extracorporeal Life Support with Small-Volume Acoustic Tweezing Thromboelastometry

Blood coagulation analysis is essential for evaluating bleeding and clotting risks, particularly in extracorporeal life support (ECLS) patients receiving preventative anticoagulant therapy, like heparin or bivalirudin. Therapy management requires continuous monitoring; however, existing methods exhibit high variability and require relatively large blood volumes, limiting their use in neonatal and pediatric care. This study assesses the ability of integrated quasistatic acoustic tweezing thromboelastometry (i-QATT), a novel noncontact technique utilizing small blood samples (6 µl), to monitor anticoagulant therapy. Integrated quasistatic acoustic tweezing thromboelastometry analysis was conducted on platelet-poor plasma samples collected from pediatric ECLS patients treated with unfractionated heparin (UFH) or bivalirudin, while heparinase was applied to neutralize the anticoagulation effect of UFH. Integrated quasistatic acoustic tweezing thromboelastometry accurately detected UFH and bivalirudin effects and UFH reversal in commercial and patient plasma samples, where clot initiation time, clotting time, and time to firm clot formation were identified as key i-QATT parameters in anticoagulant monitoring. The technique demonstrated sensitivity to anticoagulant dosage levels, effectively distinguished between different anticoagulants, and exhibited strong correlations with gold-standard plasma coagulation tests and rotational thromboelastometry. Additionally, i-QATT showed potential in assessing dynamic changes in thrombosis during the treatment period. The findings of this study highlight i-QATT’s ability to monitor anticoagulant therapy in pediatric patients.