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Predictors of postoperative bleeding in children undergoing cardiopulmonary bypass: A preliminary Italian study
Luca Spiezia1, Guido Di Gregorio2, Elena Campello1
1Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy.
Insights
Younger children, low postoperative platelets, and high D-dimer levels predict bleeding after cardiac surgery. These factors suggest consumptive coagulopathy may increase bleeding risk in pediatric patients undergoing cardiopulmonary bypass.
Area of Science:
- Pediatric Cardiac Surgery
- Hematology
- Critical Care Medicine
Background:
- Postoperative bleeding is a significant complication in children undergoing cardiopulmonary bypass (CPB).
- Previous studies on risk factors for bleeding after CPB have yielded inconsistent results.
- Identifying predictive factors for bleeding is crucial for improving patient outcomes.
Purpose of the Study:
- To retrospectively identify parameters that predict postoperative bleeding in children undergoing cardiac surgery with CPB.
- To evaluate demographic, laboratory, and perioperative factors associated with excessive blood loss.
Main Methods:
- Retrospective analysis of 83 pediatric patients (age ≥1 month) undergoing cardiac surgery with CPB.
- Collection of demographic, perioperative laboratory data, transfusion requirements, and 24-hour blood loss.
- Univariate and multivariate logistic regression to identify independent predictors of high postoperative blood loss (≥80th percentile).
Main Results:
- Younger age (<7.7 months) was significantly associated with increased postoperative bleeding (p=0.015).
- Lower postoperative platelet count (<109×10^9/L) independently predicted excessive blood loss (p=0.003).
- Higher postoperative D-dimer levels (≥2350 μg/L) were strongly linked to increased bleeding (p=0.007).
Conclusions:
- Younger age, low postoperative platelet count, and elevated D-dimer levels are potential risk factors for postoperative bleeding in pediatric cardiac surgery.
- Findings suggest that consumptive coagulopathy may contribute to bleeding complications.
- Further large-scale prospective studies are needed for early diagnosis and management of CPB-related coagulopathies.
Background:
Several characteristics such as demographics, pre-existing conditions, surgical procedure, perioperative coagulopathy may predispose children undergoing cardiopulmonary bypass (CPB) to bleeding complications. As yet, studies on risk factors for postoperative bleeding have brought mixed results. The purpose of our study was therefore to retrospectively evaluate the parameters able to predict postoperative bleeding in a group of consecutive children undergoing cardiac surgery involving CPB.
Methods:
We collected demographic and perioperative laboratory data, as well as intraoperative transfusion requirements and blood loss during the first 24h after surgery in a group of consecutive children (aged ≥1month) scheduled for cardiac surgery with CPB at Padua University Hospital between June 2014 and April 2015. Cases were patients who experienced a 24-h postoperative blood loss ≥80th percentile. Univariate and multivariate logistic regression analyses were performed to determine the independent parameters associated with a high 24-h postoperative chest tube drainage volume.
Results:
Eighty-three children (M:F 38:45; age range 1-168months) were enrolled. Age<7.7months (p 0.015), postoperative platelets <109×109/L (p 0.003) and postoperative D-dimer ≥2350μg/L (p 0.007) were the variables most significantly and independently associated with excessive 24-h postoperative blood loss.
Conclusions:
Although preliminary, our study identified younger age, lower postoperative platelet count and higher D-dimer plasma levels as possible risk factors for postoperative bleeding. As for coagulation parameters, our results suggested consumptive coagulopathy might cause a strong predisposition to postoperative bleeding in children. Large-scale prospective studies would provide insight into the early diagnosis and treatment of CPB-related coagulopathies.