Mary E Bauman

• MN- Nurse Practitioner
• University of Alberta

Anticoagulation with Vitamin K antagonists (VKA) has always posed challenges in terms of monitoring requirements. These challenges were further exacerbated in the setting of the COVID-19 pandemic, with limited access to and/or avoidance of laboratory testing. The importance of utilizing point of care (POC) health technology for individualized patie...

The use of ventricular assist devices (VADs) in children is increasing. Stroke and device-related thromboembolism remain the most feared complications associated with VAD therapy in children. The presence of a VAD causes dysregulation of hemostasis due to the presence of foreign materials and sheer forces intrinsic to the device resulting in hyperc...

The number of children receiving treatment with anticoagulants for thromboembolic complications has risen over the last decade(1). Children's physiologic response to anticoagulants is inherently different to that of adults (2-6). The complexity of anticoagulation management in the acute setting has led to the development of dedicated Anticoagulatio...

Postoperative chylothorax is a frequently encountered pathology occurring in up to 4% of patients undergoing surgery for repair of congenital heart disease. Symptomatic thrombosis is associated with chylothorax and may contribute to its severity and duration. Furthermore, vessel thrombosis resulting in persistent vessel occlusion may impede future...

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: van Miert C, Hill R, Jones L. Interventions for restoring patency of occluded central venous catheter lumens. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD007119. DoI: 10.1002/14651858.CD007119.pub2. Further information for this Coc...

CO-CHAIRS: Feldman D: Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine; Pamboukian SV: University of Alabama at Birmingham, Birmingham, Alabama; Teuteberg JJ: University of Pittsburgh, Pittsburgh, Pennsylvania TASK FORCE CHAIRS: Birks E: University of Louisville, Louisville, Kentu...

Capillary point of care (POC) International Normalized Ratio (INR) measurement within the home is a feasible method of INR testing and is associated with non-inferior warfarin / INR control when compared to traditional approaches. Due to the lack of studies providing evidence for guidance in POC INR Home testing (PIHT), consensus recommendations ha...

Bruce AK, Bauman ME, Jones S, Massicotte MP, Monagle P. Recommendations for measuring health-related quality of life in children on anticoagulation. J Thromb Haemost 2012; 10: 2596–8.

Background The need for long-term thromboprophylaxis in children using warfarin therapy is increasing. Natural health products (NHPs) are administered to children by parents who perceive them to be useful and acceptable adjuncts or alternatives to conventional therapies. Interactions of NHPs with prescribed therapies may result in serious adverse e...

The low molecular weight heparin effect in children is monitored using the anti-factor Xa level. Venipuncture is recommended; however, central venous catheter blood sampling is often necessary. Heparin infused through central venous catheters may contaminate central venous catheter blood samples, preventing reliable anti-factor Xa level measurement...

Measurement of quality of life (QOL) has been accepted as an important outcome measure in therapeutic clinical trials. Long-term antithrombotic therapy is hypothesized to induce treatment dissatisfaction and influence QOL. Health-related quality of life (HRQOL) can be measured by an inventory developed specific to the patient condition. Pediatric Q...

Arterial ischemic stroke occurs as a result of abnormal clinical circumstances that alter hemostasis and cause thrombosis, either within a vessel or as an embolic event. Understanding normal hemostasis, including differences between children (developmental hemostasis) and adults, will provide background for determining the pathophysiology of stroke...

Hemostasis is the balance between bleeding and clotting and includes coagulation and fibrinolysis with platelet interactions. Despite developmental hemostasis that describes the major differences between neonates and older children and adults, neonates do not have increased bleeding or clotting unless clinical situations disturb the "balance." Peri...

Increasing numbers of children are being administered warfarin therapy as thromboprophylaxis. Warfarin has a narrow therapeutic window with a target international normalised ratio (INR) of 2-3.5, called the therapeutic range. The length of time a patient's INR remains within the therapeutic range is calculated as 'time in the therapeutic range'. Ri...

Long term anticoagulation (LTA) is hypothesized to induce treatment dissatisfaction influence quality of life (QOL). QOL is measured by a tool developed specific to the patient condition. Pediatric QOL inventory for children on LTA should assess constructs salient for this population. Identification and evaluation of QOL constructs, critical to imp...

Increasing numbers of children require warfarin thromboprophylaxis. Home INR testing by the patient (PST) has revolutionized warfarin management. However, the family/patient must contact the health team for guidance for warfarin dosing. Patient self management(PSM) prepares a patient performing PST to take an active role in warfarin dosing. Adult s...

The age of highly specialized pediatric care has resulted in many medical and surgical successes. However, new life threatening challenges have resulted which includes thrombosis. Prior to this era, there was little data concerning the risk or occurrence of both venous and arterial thrombosis in infants and children. The studies over the last 15 ye...

Enoxaparin, a low molecular weight heparin (LMWH), is frequently used for the prevention and treatment of thromboembolic complications in infants and children (Sutor et al., 2004 [1]). Injection pain and the fear and anxiety associated with needle phobia in the pediatric population are well documented. Best practice pediatric pain management standa...

Increasing the starting dose of enoxaparin results in the early achievement of therapeutic anti-factor Xa levels in children receiving enoxaparin which is critical for effective therapy and the reduction of venipunctures. The aim of this study was: i) to determine the enoxaparin dose required to achieve therapeutic anti-factor Xa levels in infants...

Unlabelled: Enoxaparin is a low molecular weight heparin (LMWH) commonly used for thromboprophylaxis children. Enoxaparin dosing is based on patients' weight and results in decimal dosing. Due to the high concentration of enoxaparin the resultant decimal dose makes precise measurement difficult. Dilution is necessary and often results in ten-fold...

Background: Warfarin is the most commonly used oral anticoagulant, but its use is limited by the narrow therapeutic index. Single nucleotide polymorphisms in cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1) have been shown to impact warfarin dose requirements. Use of such pharmacogenetic data to improve warfarin dosing has been...

Advances in medical and surgical therapy in children have resulted in increased survival in children with primary illnesses. However, thrombosis is a serious complication of this success and results in mortality and morbidity. Prevention or treatment of thrombosis using warfarin is challenging in children due to its narrow therapeutic index and the...

Many children are surviving primary illnesses and now require thromboprophylaxis as a result of advances in management. Vitamin K antagonists are commonly prescribed to prevent or treat thrombosis. These agents are far more challenging to effectively manage in children. As a result of these challenges, frequent blood monitoring to measure internati...

Point-of-care INR (POC INR) meters can provide a safe and effective method for monitoring oral vitamin K antagonists (VKAs) in children. Stollery Children's Hospital has a large POC INR meter loan program for children requiring oral VKAs. Our protocol requires that POC INR results be compared to the standard laboratory INR for each child on several...

Decompressive hemicraniectomy has been discussed as a treatment option that increases survival in adults with malignant stroke. This approach has not been studied extensively in children. From a prospective cohort, we identified 4 children who underwent decompressive hemicraniectomy for malignant infarctions with life-threatening cerebral edema wit...

Deep vein thrombosis (DVT) is a complication of treatment of acute lymphoblastic leukemia (ALL) in children but little is known about the long-term outcomes of these DVT. Objective: To determine the incidence of post-thrombotic syndrome (PTS) in (i) children with ALL diagnosed with asymptomatic DVT using radiographic testing and (ii) an unselected...

Cerebral venous thrombosis is currently thought to be a relatively rare and benign entity in childhood. Recent studies however have shown that cerebral venous thrombosis is more common than previously believed, and carries significant mortality and neurologic morbidity. Neonates are the most commonly affected age group, compared to children �1 mont...

Cerebral venous thrombosis is currently thought to be a relatively rare and benign entity in childhood. Recent studies however have shown that cerebral venous thrombosis is more common than previously believed, and carries significant mortality and neurologic morbidity. Neonates are the most commonly affected age group, compared to children >1 mont...

BACKGROUND: Only recently, thromboembolic events have emerged as one of the most serious and frequent secondary complications to occur in children who, with modern therapy, are surviving previously life-threatening diseases. One of the most common primary disorders is congenital heart disease (CHD), accounting for approximately 1/3 of children pres...

IntroductionClincial symptoms and complications of venous thromboembolism in infants and childrenDiagnosis of venous thromboembolism in infants and childrenTreatment recommendations in infants and childrenConclusions Further reading

The use of oral anticoagulant therapy is increasing in children. Managing anticoagulant therapy in children presents unique challenges, including poor venous access. The advent of point-of-care (POC) monitoring of anticoagulant therapy offers a potential solution to this challenge. This paper reviews the published literature relating to POC monitor...

Increased numbers of children with congenital heart disease are requiring anticoagulant therapy, as many of the medical and surgical interventions aimed at curing or palliating cardiac disease are associated with an increased risk of thromboembolic complications. The prospect of managing anticoagulant therapy in children presents several unique cha...

BACKGROUND: Over the last 10 years, children with congenital heart disease (CHD) have been experiencing increased survival due to diagnostic and surgical techniques. However, associated with this is a requirement for prolonged central venous access which has serious associated sequelae, of which thrombosis is one of the most important. In a busy co...

Venous thromboembolic events (VTEs) in children are usually associated with underlying clinical conditions. The added contribution of prothrombotic conditions to the occurrence of VTEs in children is not clear. This study reports the prevalence of prothrombotic conditions in 171 consecutive children with VTE followed in the Hospital for Sick Childr...

Post-thrombotic syndrome (PTS) in adults, characterized by swelling, skin pigmentation, pain, and ulceration of the limb, is secondary to deep vein thrombosis (DVT). In contrast to the extensive documentation on PTS in adults, little is known about the risk of PTS in children. To determine the incidence, clinical characteristics, and predictors of...

The possibility has been established of production of periclase-spinel-forsterite concrete blocks with increased structural strength at 1400–1450°C and resistant to the action of of molten iron slag. Tests of the experimental blocks in the slag belt of soaking pits showed a 15–20% increase in resistance in comparison with fired chromite-periclase...

A method of production of large magnesiospinellide concrete parts for soaking pit hearths based on slag- and iron-impregnated scrap of magnesia refractories has been introduced in Khristoforovka Refractory Block and Concrete Plant. The parts have been introduced in practically all steel plants of the country, which has made it possible to industria...

The basic production parameters were developed for production of chamotte porous fillers with an apparent density of 0.35–1.3 g/cm3 by expansion of refractory clays and kaolins in the 1500–1700°C range. It was established that DN2 clay expands sufficiently effectively with a heating rate of not less than 20°C/min and KV-2 kaolin with a rate of 60°C...

We developed and tested, in industrial conditions, the main technical parameters for preparing chamotte lightweight refractories with a compressive strength of not less than 10 MPa. The pore formation of the bodies can be attained by using a porous filler of coarse grain-size composition, obtained by expanding fireclays by heat treatment, and with...

Conclusions The technicoeconomic desirability of replacing chamotte brick in the edge of soaking pits with concrete parts of bauxite or of a mixture of commercial grade chamotte and silicon carbide part scrap using high-alumina cement was shown. The life of the upper structure of the soaking pit doubled, the time for repair of this element of the l...

We established the cost-benefit advantages of the use of magnesia spinel waste (scrap) with metallic inclusions as a filler for making refractory concrete suitable for lining the bottoms of soaking pits. We recommend the construction of a section for producing magnesia spinel concretes at the Nikitovsk Dolomite Factory. It is also necessary to co...