Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic activity

Heying, Ruth; Oeveren, Wim van; Wilhelm, Stefanie; Schumacher, Katharina; Grabitz, R. G.; Messmer, Bruno J.; Seghaye, Marie-Christine

doi:10.1186/cc5108

Cited by 35 publications

(4 citation statements)

References 42 publications

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“…Many studies have demonstrated that there are differences between the coagulation profiles of children with single ventricle physiology and those of healthy children [5–9, 20, 22–26]. In 2007, Cholette et al [13] reported the first and only prior study to assess infants undergoing stage I palliation for thrombosis using echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

Tzanetos

Hernanz‐Schulman

et al. 2011

Intensive Care Med

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Purpose To determine the incidence and clinical and biomarker predictors of perioperative thrombosis in children with single ventricle physiology undergoing staged palliation. Methods Nineteen patients were enrolled and 16 completed the study. Serial ultrasounds of the central venous system were performed to evaluate for thrombus. Plasma antithrombin III, thrombin–antithrombin complex, protein C, protein S, tissue factor pathway inhibitor, plasminogen activator inhibitor-1, tissue plasminogen activator antigen, D-dimer, soluble CD40 ligand, and urinary thromboxane were measured serially before and after surgery. Cardiopulmonary bypass time, aortic cross clamp time, blood product administration, inotrope score, chest tube output, cardiac function by echocardiography, intensive care unit and hospital lengths of stay, and central venous catheter days were recorded. Results The incidence of perioperative thrombus was 31%. Patients who developed a thrombus had poorer preoperative ventricular function (p = 0.03) and longer cardiopulmonary bypass times (p = 0.03) than those who did not develop a thrombus. Preoperative plasma antithrombin III was lower (p = 0.01) and tissue plasminogen activator antigen concentrations were higher (p = 0.02) in patients with a thrombus compared with patients without a thrombus. When measured over time, antithrombin III remained lower (p = 0.002) and tissue plasminogen activator antigen higher (p = 0.005) in those who developed a thrombus compared with those who did not. There were no other statistically significant differences in biomarkers of coagulation between patients with and without thrombosis. Conclusion One-third of patients undergoing palliative surgery for single ventricle physiology develop thrombosis. Decreased ventricular function, low antithrombin III, and increased tissue plasminogen activator may predict those most suitable for randomized clinical trials of anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

Tzanetos

Hernanz‐Schulman

et al. 2011

Intensive Care Med

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“…This may manifest with increased bleeding, the need for blood products, and prolonged surgical times. Moreover, low postoperative AT level increases the risk of thrombosis in vulnerable patients with shunts, indwelling central lines, surgical stress and low-flow cardiac output states post-CPB [ [37] , [38] , [39] ]. As AT has a biological half-life of 2.5 days, it may reduce postoperative blood loss and blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

The effect of perioperative antithrombin supplementation on blood conservation and postoperative complications after cardiopulmonary bypass surgery: A systematic review, meta-analysis and trial sequential analysis

Li,

Bo,

Meng

et al. 2023

Heliyon

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“…Cardiac surgery increases the likelihood of post-operative thromboembolic complications in both children and adults ( 4 , 26 – 28 ). The reported increased risk of thrombosis following Fontan surgery is likely multi-factorial, owing to the insertion of central venous lines, the use of cardiopulmonary bypass and the variable surgical manipulation of tissue ( 29 – 31 ). Recent studies have also suggested that the altered hemodynamics resulting from stenosis and thrombosis may be related to the graft material selected and the Fontan procedure performed ( 12 ), with Deshaies et al specifying a possible lower thromboembolic risk in the case of extracardiac conduit Fontan surgery ( 32 ).…”

Section: Te Post-fontan Surgerymentioning

confidence: 99%

Increased Risk for Thromboembolism After Fontan Surgery: Considerations for Thromboprophylaxis

et al. 2022

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The Fontan circulation introduces an increased risk of thromboembolism which is associated with substantial mortality and morbidity. Adverse outcomes of thromboembolic complications post-Fontan surgery vary in both nature and severity, ranging from local tissue infarction and pulmonary embolism to Fontan failure and ischemic stroke. Furthermore, recent studies have identified that subclinical stroke is common yet underdiagnosed in Fontan patients. Fontan patients are commonly treated with antiplatelet agents and/or anticoagulants as primary thromboprophylaxis. Optimal thromboprophylaxis management in the Fontan population is still unclear, and clinical consensus remains elusive despite the growing literature on the subject. This perspective will describe the nature of thromboembolism post-Fontan surgery and provide evidence for the use of both current and emerging thromboprophylaxis options for children and adults living with Fontan circulation.

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Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic activity

Cited by 35 publications

References 42 publications

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

The effect of perioperative antithrombin supplementation on blood conservation and postoperative complications after cardiopulmonary bypass surgery: A systematic review, meta-analysis and trial sequential analysis

Increased Risk for Thromboembolism After Fontan Surgery: Considerations for Thromboprophylaxis

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