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Coagulation management in pediatric mechanical circulatory support
Thorsten Drews1, Brigitte Stiller, Michael Hübler
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Insights
A new anticoagulation regimen improved outcomes for children on mechanical circulatory support devices. This new treatment reduced complications and significantly increased long-term survival rates in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Hematology
Background:
- Mechanical circulatory support (MCS) devices are critical for children with heart failure.
- Optimizing anticoagulation in pediatric patients on MCS is essential to prevent thrombotic and bleeding complications.
- Previous anticoagulation protocols had significant associated risks.
Purpose of the Study:
- To compare the efficacy and safety of a new anticoagulation regimen versus a traditional one in children with pulsatile assist devices.
- To evaluate the impact of different anticoagulation strategies on clinical outcomes, including bleeding, thromboembolism, and survival.
Main Methods:
- Retrospective analysis of 40 children (Group A) on a former anticoagulation treatment and 32 children (Group B) on a new regimen.
- Comparison of complication rates (bleeding, cerebral hemorrhage, thromboembolism, stroke) and re-exploration rates.
- Assessment of device support duration and long-term survival.
Main Results:
- Group B showed lower incidences of bleeding complications (38% vs 47.5%), chest re-exploration (25% vs 35%), and strokes (6% vs 15%) compared to Group A.
- Thromboembolic events were similar between groups (22% vs 23%).
- Mean support time was longer in Group B (57 days vs 19 days), with significantly higher long-term survival (78% vs 33%, p=0.003).
Conclusions:
- The new anticoagulation regimen in pediatric patients on pulsatile assist devices is associated with reduced complications and improved long-term survival.
- Despite improvements, thrombogenicity remains a significant challenge, necessitating further research and treatment optimization.
- This study highlights the potential for enhanced anticoagulation strategies to improve outcomes in pediatric mechanical circulatory support.
Abstract:
The anticoagulation treatment of children on pulsatile assist devices was studied. The results of 40 children (group A) on mechanical circulatory support with the formerly used anticoagulation treatment were compared with 32 children (group B) on assist devices treated with a new anticoagulation regime. In groups A and B, respectively, 19 (47.5%) and 12 (38%) had bleeding complications; 14 (35%) and 8 (25%) had chest re-exploration; 2 (5%) and 1 (3%) had cerebral hemorrhage; 9 (23%) and 7 patients (22%) had thromboembolic events; and 6 (15%) and 2 (6%) had strokes. In groups A and B, respectively, mean time of support was 19 days (range, 0 to 111 days) and 57 days (range, 1 to 420 days), with long-term survival of 33% and 78%. The differences in survival were significant (alpha = 0.003). Embolic and bleeding complications were seen in both groups, but the incidence was lower in group B. Since, however, thrombogenicity of the systems continues to be their main problem, further improvement of treatment is required.
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