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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
Summary
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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