Kaolin‐activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study

Abstract

According to our findings, cyanosis does not affect TEG parameters in children with CHD. PLT count and plasma fibrinogen significantly correlated (are significantly associated) with MA and MA-fib respectively, suggesting that use of TEG after protamine administration may be prompted for improved hemostatic monitoring in the perioperative phase.

Hemostasis in Pediatric Cardiac Surgery

“…Children with cyanotic heart disease had more bleeding, but the difference disappeared when the analysis was adjusted for duration of CPB. 15 Although there was a significant increase in hematocrit in the cyanotic group in the latter study, the median level of hematocrit was only 45%. 15 This may potentially explain the difference to a previous study in adults with cyanotic heart disease, where the fibrinogen function was significantly impaired, but this observation was done in a study population with a mean hematocrit of 57%.…”

“…In the study by Rizza et al, where the specific aim was to evaluate the importance of cyanotic heart disease, there were no differences in TEG baseline values between cyanotic and acyanotic children. 15 This observation was recently confirmed in a larger study with preoperative samples from 413 children with or without cyanotic heart defects. 23 Furthermore, there were no differences in TEG values between the two groups during and after CPB.…”

“…1,4,15 Quite interestingly, changes outside the age-adjusted reference interval were observed for aPTT, PT, and TT in 40, 82, and 65% of children after surgery in one study, 1 whereas abnormalities in fibrinogen have been much more pronounced in other studies. 4,15 The predictive values (PV) of severe bleeding are comparable to those of viscoelastic tests, with positive-PV values ranging from 29 to 63% and negative-PV from 76 to 87%. 1,4 In adult cardiac surgery, factor XIII depletion has been associated with major bleeding complications.…”

“…The most pronounced changes postoperatively are found with respect to aPTT, which is normally prolonged after CPB both with and without residual heparinization 1,4,15 ; however, also fibrinogen, prothrombin time (PT ratio), and thrombin time (TT) are significantly altered after CPB. 1,4,15 Quite interestingly, changes outside the age-adjusted reference interval were observed for aPTT, PT, and TT in 40, 82, and 65% of children after surgery in one study, 1 whereas abnormalities in fibrinogen have been much more pronounced in other studies. 4,15 The predictive values (PV) of severe bleeding are comparable to those of viscoelastic tests, with positive-PV values ranging from 29 to 63% and negative-PV from 76 to 87%.…”

“…In general, significant impairment of hemostasis, reflected in all ROTEM variables, has been observed in blood samples obtained immediately after CPB. 1,2,4,15,18,19,21 However, the observed changes in ROTEM variables have been associated with poor positive-PV for bleeding, namely between 18 and 60%, whereas the negative-PV were between 76 and 87%, indicating that treatment should not be based solely on viscoelastic test measurements.…”