Risk Factors, Prophylaxis, and Treatment of Venous Thromboembolism in Congenital Heart Disease Patients

Abstract

Congenital heart disease (CHD) is a common condition in the pediatric population, affecting up to 1% of all live births (i.e., around 40,000 newborns/year in the United States). Although CHD does have a wide range of severity, by the age of 5 years approximately 80% of patients will require at least one surgical intervention to achieve a complete/palliative cardiac repair. Today, in light of their much-improved surgical survival, the care of these patients focuses on morbidity prevention and/or treatment. One such morbidity has been the increased frequency of thrombotic occlusions [e.g., cardioembolic arterial ischemic strokes; arterial, cardiac, and/or newly created shunt thrombosis; venous thromboembolism (VTE)]. Patients with CHD are at high risk of developing thrombosis due to the disruption of blood flow, CHD-related coagulopathy, inflammation, and/or platelet activation secondary to extracorporeal circulation support required during open-heart surgery or as a bridge to recovery, which can increase thrombus formation. In this article, we will discuss how the coagulation system is altered in patients with CHD in regard to the patient’s anatomy, procedures they undergo to correct their congenital heart defect, and other risk factors that may increase their thrombotic risk, focusing on VTE. We will also discuss the most recently published reports pertaining to guidelines on prophylaxis and treatment of VTE in this population. Finally, we will briefly address the long-term VTE outcomes for patients with CHD.

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

“…[2,20,21,[27][28][29] Patients with congenital heart disease have been reported as having high VTE rates in the literature, owing to the need for surgical intervention, alterations in blood flow, and need for CVCs. [30,31] VTE rates after congenital cardiac surgery have been reported from 3.9% to 31%, much higher than most other surgical subspecialties in our database and in the literature. [32,33] Four of the top procedures in the present analysis were colectomies, although the gastrointestinal procedure with the highest VTE rate was first stage omphalocele repair.…”

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

“…[2,20,21,[27][28][29] Patients with congenital heart disease have been reported as having high VTE rates in the literature, owing to the need for surgical intervention, alterations in blood flow, and need for CVCs. [30,31] VTE rates after congenital cardiac surgery have been reported from 3.9% to 31%, much higher than most other surgical subspecialties in our database and in the literature. [32,33] Four of the top procedures in the present analysis were colectomies, although the gastrointestinal procedure with the highest VTE rate was first stage omphalocele repair.…”

Recurrent Thromboembolism in Pediatric Congenital Heart Disease: Cumulative Incidence and Prognostic Factors

“…Additionally, we identified other potentially clinically meaningful associations with TE recurrence that may require further investigation, including index VTE, hospitalization within the prior 30 days, and cardiac surgery. While some of these factors have been previously reported as risk factors for index VTE, 16 17 18 we have now identified them also as potential risk factors for recurrent TE events. Of note, we were unable to find an association between a recent cardiac catheterization and the development of recurrent TE.…”

Incidence, Risk Factors, and Outcomes of Neonatal Renal Vein Thrombosis in Ontario: Population-Based Cohort Study

“…Both respiratory distress syndrome and congenital heart disease are associated with increased risk of thrombosis through alterations in coagulation systems (22,23). Additionally, congenital heart disease predisposes neonates to thrombosis due to alterations in blood flow (23). We found that central venous catheterization conferred a threefold increased risk of developing nRVT.…”

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

“…[2,20,21,[27][28][29] Patients with congenital heart disease have been reported as having high VTE rates in the literature, owing to the need for surgical intervention, alterations in blood flow, and need for CVCs. [30,31] VTE rates after congenital cardiac surgery have been reported from 3.9% to 31%, much higher than most other surgical subspecialties in our database and in the literature. [32,33] Four of the top procedures in the present analysis were colectomies, although the gastrointestinal procedure with the highest VTE rate was first stage omphalocele repair.…”

Recurrent Thromboembolism in Pediatric Congenital Heart Disease: Cumulative Incidence and Prognostic Factors

“…Additionally, we identified other potentially clinically meaningful associations with TE recurrence that may require further investigation, including index VTE, hospitalization within the prior 30 days, and cardiac surgery. While some of these factors have been previously reported as risk factors for index VTE, 16 17 18 we have now identified them also as potential risk factors for recurrent TE events. Of note, we were unable to find an association between a recent cardiac catheterization and the development of recurrent TE.…”

Incidence, Risk Factors, and Outcomes of Neonatal Renal Vein Thrombosis in Ontario: Population-Based Cohort Study

“…Both respiratory distress syndrome and congenital heart disease are associated with increased risk of thrombosis through alterations in coagulation systems (22,23). Additionally, congenital heart disease predisposes neonates to thrombosis due to alterations in blood flow (23). We found that central venous catheterization conferred a threefold increased risk of developing nRVT.…”

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

“…[2,20,21,[27][28][29] Patients with congenital heart disease have been reported as having high VTE rates in the literature, owing to the need for surgical intervention, alterations in blood flow, and need for CVCs. [30,31] VTE rates after congenital cardiac surgery have been reported from 3.9% to 31%, much higher than most other surgical subspecialties in our database and in the literature. [32,33] Four of the top procedures in the present analysis were colectomies, although the gastrointestinal procedure with the highest VTE rate was first stage omphalocele repair.…”

Recurrent Thromboembolism in Pediatric Congenital Heart Disease: Cumulative Incidence and Prognostic Factors

“…Additionally, we identified other potentially clinically meaningful associations with TE recurrence that may require further investigation, including index VTE, hospitalization within the prior 30 days, and cardiac surgery. While some of these factors have been previously reported as risk factors for index VTE, 16 17 18 we have now identified them also as potential risk factors for recurrent TE events. Of note, we were unable to find an association between a recent cardiac catheterization and the development of recurrent TE.…”

Incidence, Risk Factors, and Outcomes of Neonatal Renal Vein Thrombosis in Ontario: Population-Based Cohort Study

“…Both respiratory distress syndrome and congenital heart disease are associated with increased risk of thrombosis through alterations in coagulation systems (22,23). Additionally, congenital heart disease predisposes neonates to thrombosis due to alterations in blood flow (23). We found that central venous catheterization conferred a threefold increased risk of developing nRVT.…”