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Bleeding and thrombotic emergencies in pediatric cardiac intensive care: unchecked balances

Therese M Giglia1, James Dinardo, Nancy S Ghanayem

  • 1Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

World Journal for Pediatric & Congenital Heart Surgery
|June 28, 2013
PubMed

Insights

Children with heart conditions in the cardiac intensive care unit (CICU) face risks of bleeding and clotting. This review covers their hematologic complications, management, and monitoring strategies.

Area of Science:

  • Pediatric Cardiology
  • Hematology
  • Intensive Care Medicine

Background:

  • Children in the cardiac intensive care unit (CICU) with congenital or acquired heart disease are susceptible to hematologic complications, including hemorrhage and thrombosis.
  • The precise incidence of these complications in the CICU remains undetermined, though specific risk factors and patient groups with disrupted hemostasis are recognized.

Purpose of the Study:

  • To review the propensity for bleeding and clotting complications in pediatric CICU patients with heart disease.
  • To discuss management strategies for life-threatening hematologic events, including perioperative bleeding, thrombosis in single-ventricle patients, shunt clotting, mechanical valve thrombosis, and stroke.
  • To examine the monitoring of anticoagulation and thrombolysis, current diagnostic and therapeutic modalities, and future directions in CICU hematology.

Main Methods:

  • Literature review focusing on hematologic complications in pediatric cardiac intensive care.
  • Analysis of bleeding and clotting risks associated with congenital and acquired heart diseases.
  • Discussion of diagnostic modalities, medications, and management strategies for thrombotic and hemorrhagic events.

Main Results:

  • Children with heart disease in the CICU are at significant risk for both bleeding and clotting disorders.
  • Specific conditions like single-ventricle physiology, Blalock-Taussig shunts, and mechanical valves are associated with thrombotic risks.
  • Stroke is a notable hematologic complication in this patient population.

Conclusions:

  • Effective management of hematologic complications in the CICU necessitates a thorough understanding of bleeding and clotting risks.
  • Prevention remains the cornerstone of management, but prompt recognition and intervention for acute events are critical.
  • Further research into diagnostics, therapeutics, and monitoring is essential for improving outcomes in pediatric CICU patients with hematologic complications.

Keywords:
blood: coagulation/anticoagulationcongenital heart diseasecongenital heart surgeryperioperative carepostoperative carethrombosis

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