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Thromboelastography of patients after fontan compared with healthy children
Leslie Raffini1, Alexander Schwed, X Long Zheng
1Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA. raffini@email.chop.edu
Insights
Thromboelastography did not detect hypercoagulability in pediatric Fontan patients, despite their increased risk of blood clots. This suggests the assay may not identify this specific complication in Fontan survivors.
Area of Science:
- Pediatric Cardiology
- Hematology
- Coagulation Science
Background:
- Patients with a Fontan procedure have a higher risk of thromboembolic complications.
- Assessing hypercoagulability is crucial for managing this risk.
Purpose of the Study:
- To evaluate thromboelastography's ability to detect hypercoagulability in pediatric Fontan patients.
- To compare coagulation status in Fontan patients versus healthy children.
Main Methods:
- Prospective, cross-sectional study of 25 Fontan patients and 51 healthy children across three age groups.
- Kaolin-activated thromboelastography performed on citrated blood samples.
- Analysis of thromboelastography parameters to identify hypercoagulability.
Main Results:
- No significant differences in thromboelastography parameters were found among healthy children's age groups.
- None of the Fontan patients showed evidence of hypercoagulability (95% CI, 0-7%).
- The observed rate of hypercoagulability was lower than the known incidence of thromboembolic complications.
Conclusions:
- Thromboelastography did not identify hypercoagulability in pediatric Fontan patients in this cohort.
- The utility of thromboelastography for predicting thromboembolic risk in Fontan patients remains unknown.
- Further research is needed to correlate thromboelastography findings with clinical thromboembolic events.
Abstract:
Patients who have undergone a Fontan procedure face an increased risk for thromboembolic complications. This study aimed to evaluate whether thromboelastography, a global whole-blood assay of coagulation, can be used to detect hypercoagulability in pediatric Fontan patients compared with healthy children. This prospective, cross-sectional study investigated 25 Fontan patients and 51 healthy children in three age groups: 1-5 years, 6-10 years, and 11-16 years. Kaolin-activated thromboelastography was performed on citrated samples. No statistically significant differences in thromboelastography parameters were found among the different age groups of the 51 healthy children. None of the 25 Fontan patients demonstrated evidence of hypercoagulability on thromboelastography (95% confidence interval, 0-7%), as defined by two standard deviations above or below the normal mean. The findings suggest that the percentage of Fontan patients demonstrating hypercoagulability on thromboelastography is substantially lower than the reported incidence of thromboembolic complications. Whether thromboelastography could be helpful in predicting patients at increased risk for thromboembolic complications or not still is not known. Further studies comparing the thromboelastography of Fontan patients with the thromboembolic complications of those without Fontan are needed to delineate these issues.
