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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2012

01-01-2012 | Pediatric Original

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

Authors: Deanna R. Todd Tzanetos, Chang Yu, Marta Hernanz-Schulman, Frederick E. Barr, Nancy J. Brown

Published in: Intensive Care Medicine | Issue 1/2012

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Abstract

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.
Literature
1.
Monagle P (2005) Thrombosis in children with BT shunts, Glenns, and Fontans. Prog Pediatr Cardiol 21:17–21CrossRef
2.
Petaja J, Lundstrom U, Sairanen H, Marttinen E, Griffin J (1996) Central venous thrombosis after cardiac operations in children. J Thorac Cardiovasc Surg 112:883–889PubMedCrossRef
3.
Fenton K, Siewers R, Rebovich B, Pigula F (2003) Interim mortality in infants with systemic-to-pulmonary artery shunts. Ann Thorac Surg 76:152–156PubMedCrossRef
4.
Monagle P, Chalmers E, Chan A, DeVeber G, Kirkham F, Massicotte P et al (2008) Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133:887S–968SPubMedCrossRef
5.
Ravn HB, Hjortdal VE, Stenbog EV, Emmertsen K, Kromann O, Pedersen J et al (2001) Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart 85:61–65PubMedCrossRef
6.
Cromme-Dijkhuis AH, Henkens CMA, Bijleveld CMA, Hillege HL, Bom VJJ, Van der Meer J (2001) Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations. Lancet 336:1087–1090CrossRef
7.
Jahangiri M, Shore D, Kakkar V, Lincoln C, Shinebourne E (1997) Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg 113:989–992PubMedCrossRef
8.
Odegard KC, McGowan FX Jr, Zurakowski D, DiNardo JA, Castro RA, del Nido PJ et al (2002) Coagulation factor abnormalities in patients with single-ventricle physiology immediately prior to the Fontan procedure. Ann Thorac Surg 73:1770–1777PubMedCrossRef
9.
Odegard KC, McGowan FX Jr, Zurakowski D, DiNardo JA, Castro RA, del Nido PJ (2002) Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 125:1260–1267CrossRef
10.
Rosenthal DN, Friedman AH, Kleinman CS, Kopf GS, Rosenfeld LE, Hellenbrand WE (1995) Thromboembolic complications after Fontan operations. Circulation 92:287–293
11.
Coon PD, Rychik J, Novello RT, Ro PS, Gaynor JW, Spray TL (2001) Thrombus formation after the Fontan operation. Ann Thorac Surg 71:1990–1994PubMedCrossRef
12.
Monagle P, Andrew M (1998) Coagulation abnormalities after Fontan. J Thorac Cardiovasc Surg 115:732–733PubMedCrossRef
13.
Cholette JM, Rubenstein JS, Alfieris GM, McDermott MP, Harmon WG, Vermilion R et al (2007) Elevated risk of thrombosis in neonates undergoing initial palliative cardiac surgery. Ann Thorac Surg 84:1320–1325PubMedCrossRef
14.
Agarwal HS, Churchwell KB, Doyle TP, Christian KG, Drinkwater DC Jr, Byrne DW et al (2006) Inhaled nitric oxide use in bidirectional Glenn anastomosis for elevated Glenn pressures. Ann Thorac Surg 81:1429–1434PubMedCrossRef
15.
Morrow JD, Minton TA (1993) Improved assay for the quantification of 11-dehydrothromboxane B2 by gas chromatography-mass spectrometry. J Chromatogr 612:79–85
16.
Nowak-Gottl U, Kotthoff S, Hagemeyer E, Junker R, Kehl HG, Vielhaber H, Kececioglu D (2001) Interaction of fibrinolysis and prothrombotic risk factors in neonates, infants and children with and without thromboembolism and underlying cardiac disease. A prospective study. Thromb Res 103:93–101PubMedCrossRef
17.
Wiman B, Andersson T, Hallqvist J, Reuterwall C, Ahlbom A, de Faire U (2000) Plasma levels of tissue plasminogen activator/plasminogen activator inhibitor-1 complex and von Willebrand factor are significant risk markers for recurrent myocardial infarction in the Stockholm Heart Epidemiology Program (SHEEP) study. Arterioscler Thromb Vasc Biol 20:2019–2023PubMedCrossRef
18.
Geppert A, Graf S, Beckmann R, Hornykewycz S, Schuster E, Binder B et al (1998) Concentration of endogenous tPA antigen in coronary artery disease: relation to thrombotic events, aspirin treatment, hyperlipidemia, and multivessel disease. Arterioscler Thromb Vasc Biol 18:1634–1642PubMedCrossRef
19.
Chandler WL, Alessi MC, Aillaud MF, Henderson P, Vague P, Juhan-Vague I (1997) Clearance of tissue plasminogen activator (TPA) and TPA/plasminogen activator inhibitor type 1 (PAI-1) complex: relationship to elevated TPA antigen in patients with high PAI-1 activity levels. Circulation 96:761–768PubMed
20.
Odegard KC, Zurakowski D, DiNardo JA, Castro RA, McGowan FX, Neufeld EJ et al (2009) Prospective longitudinal study of coagulation profiles in children with hypoplastic left heart syndrome from stage I through Fontan completion. J Thorac Cardiovasc Surg 137:934–941PubMedCrossRef
21.
Hasaniya NW, Razzouk AJ, Mulla NF, Larsen RL, Bailey LL (2010) In situ pericardial extracardiac lateral tunnel Fontan operation: fifteen-year experience. J Thorac Cardiovasc Surg 140:1076–1083PubMedCrossRef
22.
Jahangiri M, Kreutzer J, Zurakowski D, Bacha E, Jonas RA (2000) Evaluation of hemostatic and coagulation factor abnormalities in patients undergoing the Fontan operation. J Thorac Cardiovasc Surg 120:778–782PubMedCrossRef
23.
Cheung EWY, Chay GW, Ma ESK, Cheung YF (2005) Systemic oxygen saturation and coagulation factor abnormalities before and after the Fontan procedure. Am J Cardiol 96:1571–1575PubMedCrossRef
24.
van Nieuwenhuizen RC, Peters M, Lubbers LJ, Trip MD, Tijssen JGP, Mulder BJM (1999) Abnormalities in liver function and coagulation profile following the Fontan procedure. Heart 82:40–46PubMed
25.
Procelewska M, Kolcz J, Januszewska K, Mroczek T, Malec E (2007) Coagulation abnormalities and liver function after hemi-Fontan and Fontan procedures—the importance of hemodynamics in the early postoperative period. Eur J Cardiothorac Surg 31:866–872PubMedCrossRef
26.
Heying R, van Oeveren W, Wilhelm S, Schumacher K, Grabitz RG, Messmer BJ et al (2006) Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic activity. Crit Care 10:R165PubMedCrossRef
Metadata
Title
Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology
Authors
Deanna R. Todd Tzanetos
Chang Yu
Marta Hernanz-Schulman
Frederick E. Barr
Nancy J. Brown
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2378-y

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