Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children

Abstract

These preliminary TEG results indicate that the coagulation-fibrinolytic system in CCHD patients <1 yr is functionally intact and balanced but at a lower level than in healthy children. This could be interpreted as a reduction in the haemostatic potential with less reserve.

Using reagent-supported thromboelastometry (ROTEM®) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest

“…2-4 are depicted as geometric means together with their 95% confidence intervals (95% CI) if not otherwise specified. Apart from one study by Haizinger et al reporting CT values of infants with congenital heart disease (CHD) [14] reference values of ROTEM W data are only scarcely available for infants and children. To link our results with ROTEM W reference values as reported in the literature our data are given together with reference ranges of an adult population for the CT and A10 of in-TEM W , ex-TEM W and fib-TEM W [13] and with the CT values of in-TEM W and hep-TEM W of the report on CHD patients [14].…”

Thromboelastometry in neonates and infants undergoing cardiac surgery

“…(20) Shortened EXTEM-CT in infants receiving PGE 1 24h after surgery (t 3 ) can be explained by the comparatively younger age of infants receiving PGE 1 and by the already described "hypercoagulability state" in the first three months of life. (14,18) In conclusion, cardiac surgery on cardiopulmonary bypass in our neonates and infants predominantly affected platelets, although most of the ROTEM parameters deteriorated. ROTEM might be especially useful in evaluation of neonates and infants after cardiac surgery on cardiopulmonary bypass, who bleed excessively and in whom standard therapy in our ICU (packed red blood cells and fresh frozen plasma) is insufficient.…”

Challenges and Priorities for Research

“…However, there is a paucity of normative data for this method. [33][34][35][36] To learn more about these measures, clinical studies should confirm normative values using similar testing method, establish the relationship of abnormal test results to outcomes (bleeding or thrombosis), and explore the utility of testing in patient management.…”

“…At this time, neither technical nor clinical aspects of global assays of coagulation have been sufficiently standardized to predict their relevance in clinical trials of children with heart disease. 36,69,70 The current inclusion of biomarker assessment in trials of novel anticoagulants might identify biomarkers that predict outcomes and inform the design of future trials.…”