Predicting and Treating Coagulopathies After Cardiopulmonary Bypass in Children

Miller, Bruce E.; Mochizuki, Toshiaki; Levy, Jerrold H.; Bailey, James M.; Tosone, Steven R.; Tam, Vincent K.H; Kanter, Kirk R.

doi:10.1213/00000539-199712000-00003

Cited by 164 publications

(105 citation statements)

References 17 publications

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“…[25][26][27][28][29][30][31][32][33][34] Some have found a positive correlation between APTT and postoperative hemorrhage following cardiac surgery. 26,28,30,[35][36][37][38][39] Very few studies, in fact, have specified their transfusion algorithms for the management of hemorrhage, [26][27][28]40 thus making it difficult to ascertain how elevated APTT was interpreted and dealt with in most studies.…”

Section: Discussionmentioning

confidence: 99%

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Taneja

Marwaha

Sinha

et al. 2009

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Taneja

Marwaha

Sinha

et al. 2009

Can J Anesth/J Can Anesth

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“…26 For pediatric open heart surgery, risk factors clearly associated with increased blood loss include: age less than one month, body weight under 8 kg, complexity of the procedure (arterial switches for transposition of the great vessels, Fontan procedures, Glenn shunts and truncus arteriosus repairs), duration of cardiopulmonary bypass, resternotomy, and low platelet count during cardiopulmonary bypass. 1,5,[27][28][29][30] For pediatric liver transplants, apart from retransplantation, factors that have been associated with increased intraoperative blood losses include: hypoplastic portal vein, use of a reduced-size liver graft, requirement of in-hospital supportive care, intra-abdominal malformations and signs of severe liver failure (encephalopathy, ascites, prolonged PT). 20,[31][32][33] Children younger than two years, and particularly those under one year of age experience higher blood loss.…”

mentioning

confidence: 99%

“…For example, in infants less than 8 kg of body weight who have undergone open heart surgery, coagulation factor levels are better restored by cryoprecipitates than by fresh frozen plasma, which may induce further dilution of coagulation factors. 27 If cryoprecipitates are unavailable, specific factor concentrates may be used.…”

mentioning

confidence: 99%

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Guay

Moerloose

Lasne

2006

Can J Anesth/J Can Anesth

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Purpose: To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. Methods:The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery. Main findings:For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while antikallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants. Conclusion:Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery. I N normal children perioperative blood loss leading to administration of allogenic transfusion may be encountered if: the surgical site does not allow easy access to surgical hemostasis, the surgery is performed on highly vascularized tissues that are not easily sutured or cauterized (for example bone elements such as in spinal fusion or correction of craniosynostosis) or the surgery itself induces various disturbances of hemostasis (dilution of factors and induction of fibrinolysis as in cardiac surgery with the use of extracorporeal bypass). The pathology justifying the surgical procedure may also induce various coagulation and/or hemostatic abnormalities. Children suffering from congenital cardiac or liver dis- ease may have thrombocytopenia, abnormal platelet function (congenital heart disease) and/or inadequate amounts of various coagulation factors. Objectif1 Perioperative management of children with congenital coagulation and hemostatic diseases will not be discussed in this review. Developmental aspects of hemostasisAn excellent summary of the developmental physiology of coagulation, based mainly on the extensive work of Maureen Andrew, may be found in a recent review by Kuhle et al. and is summarized in Table I.2 Since maternal coagulation factors do not cross the placental barrier, blood levels measured at birth are the result of fetal synthesis that starts around the fifth week of gestation. Fetal blood becomes clottable around 11 weeks of gestation. Except fetal fibrinogen which has an increased content of sialic acid, all coagulation and inhibitor factors are qualitatively normal at birth, and differ from...

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“…[254][255][256] In neonates, the platelet count then rises over the subsequent few weeks after surgery, thus supporting the management strategy of using antiplatelet therapies.…”

Section: Postoperative Risk Factors For Early Thrombosismentioning

confidence: 95%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

283

245

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Predicting and Treating Coagulopathies After Cardiopulmonary Bypass in Children

Cited by 164 publications

References 17 publications

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

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