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Tissue factor-activated thromboelastograms in children undergoing cardiac surgery: baseline values and comparisons
Bruce E Miller1, Nina A Guzzetta, Steven R Tosone
1Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
Insights
Tissue factor-activated thromboelastograms provide rapid insights into blood clotting in children under two. Established baseline values aid in interpreting results and managing coagulopathies in pediatric cardiac surgery patients.
Area of Science:
- Pediatric Anesthesiology
- Hemostasis and Thrombosis
- Coagulation Diagnostics
Background:
- Thromboelastography (TEG) is crucial for assessing blood coagulation.
- Tissue factor (TF)-activated TEG offers rapid evaluation but requires age-specific baseline data.
- Pediatric cardiac surgery patients often present with complex coagulopathies.
Purpose of the Study:
- To establish baseline values for TF-activated TEG in infants and young children (<2 years) undergoing cardiac surgery.
- To analyze the impact of age on TF-activated TEG variables in this population.
- To provide data for improved interpretation and clinical application of TF-activated TEG in pediatric patients.
Main Methods:
- TF-activated TEG was performed on 250 children younger than 2 years undergoing cardiac surgery.
- Participants were categorized into five age groups: <30 days, 1-3 months, 3-6 months, 6-12 months, and 12-24 months.
- Coagulation variables including R, K, alpha, and maximum amplitude were analyzed.
Main Results:
- Activation of clotting (R and K values) and fibrinolysis were similar across all age groups.
- Infants aged 1-3 months showed increased clot strength compared to other groups.
- Alpha and maximum amplitude values were remarkably consistent across all age groups, facilitating faster interpretation.
Conclusions:
- Established baseline TF-activated TEG values are crucial for accurate interpretation in young children.
- These data support the use of TF-activated TEG in managing coagulopathies in pediatric cardiac surgery.
- The consistency of alpha and maximum amplitude simplifies rapid assessment in this demographic.
Unlabelled:
Activation of clotting with tissue factor (TF) allows rapid evaluation of thromboelastograms but alters the values of thromboelastogram variables. We have performed TF-activated thromboelastograms in 250 children <2 yr old undergoing cardiac surgery to establish baseline values. Five groups were distinguished to evaluate the effects of quantitative deficiencies in coagulation factor levels during infancy: <30 days, 1-3 mo, 3-6 mo, 6-12 mo, and 12-24 mo. Activation of clotting (R and K values) was similar among groups. Infants 1-3 mo of age demonstrated increased clot strength compared with the other groups, a finding similar to previous evaluation of native thromboelastograms. The alpha and maximum amplitude values were numerically almost identical in each age group, a unique finding in activated thromboelastograms. Fibrinolysis was similar among groups. We believe that knowledge of baseline TF-activated thromboelastogram variables in young children will be useful in interpreting these thromboelastograms in clinical scenarios, in using these thromboelastograms as part of coagulopathy treatment algorithms, and during the application of more specific thromboelastogram modifiers. Additionally, the similarity of alpha and maximum amplitude values in each age group will allow even faster interpretation of thromboelastogram data.
Implications:
Baseline values for tissue factor-activated thromboelastograms in young children undergoing cardiac surgery have been established and will permit accurate use and interpretation of this thromboelastogram modification in evaluating and managing coagulopathies.
