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Anticoagulation in children undergoing cardiac surgery

Katharina E Thom1, Andreas Hanslik, Christoph Male

  • 1Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. katharina.thom@meduniwien.ac.at

Seminars in Thrombosis and Hemostasis
|December 22, 2011
PubMed

Insights

Children with congenital heart disease (CHD) undergoing complex surgeries face a high risk of thrombosis. Optimal anticoagulant strategies for these pediatric patients remain unclear, often relying on adult data.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Hematology

Background:

  • Improved survival in congenital heart disease (CHD) reveals significant complications like thrombosis.
  • Pediatric single ventricle physiology often necessitates staged palliative surgeries (Blalock-Taussig shunt, Glenn, Fontan).
  • Cardiopulmonary bypass (CPB) during surgery impacts coagulation and induces inflammation.

Purpose of the Study:

  • To review surgical procedures (shunts, valves, CPB) associated with thrombotic risks in CHD.
  • To highlight the lack of evidence and consensus on anticoagulant prophylaxis and treatment in pediatric CHD patients.

Main Methods:

  • Review of surgical procedures: Blalock-Taussig shunt (BTS), Glenn shunt, Fontan shunt.
  • Analysis of thrombotic complications related to prosthetic mechanical valves.
  • Examination of the impact of cardiopulmonary bypass (CPB) on coagulation.

Main Results:

  • Specific surgical interventions and CPB are linked to increased thrombotic risk in CHD.
  • Current anticoagulant recommendations are largely extrapolated from adult data.
  • There is a significant gap in evidence for pediatric-specific anticoagulant strategies.

Conclusions:

  • Thrombosis is a critical complication in surgically palliated CHD.
  • Optimal anticoagulation for children with CHD requires further research and pediatric-specific guidelines.
  • Addressing thrombotic risks in CHD necessitates tailored approaches beyond adult recommendations.

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