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Calibrated automated thrombogram values in infants with cardiac surgery before and after cardiopulmonary bypass
Alessandra Rizza1, Giovina Di Felice2, Rosa Luciano2
1Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Cardiac Anesthesia/Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165 Roma, Italy.
Insights
Thrombin generation is impaired in infants undergoing cardiac surgery, especially those under six months. This coagulopathy persists post-surgery despite blood product transfusions, indicating limitations of standard tests.
Area of Science:
- Pediatric Cardiology
- Hemostasis and Thrombosis
- Cardiovascular Surgery
Background:
- Impaired thrombin generation is linked to increased bleeding after pediatric cardiac surgery with cardiopulmonary bypass (CPB).
- Congenital heart disease in children can affect coagulation, necessitating detailed evaluation.
Purpose of the Study:
- To assess standard coagulation assays, calibrated automated thrombogram (CAT), thromboelastography (TEG), and procoagulant phospholipids (PPL) in infants undergoing cardiac surgery with CPB.
- To investigate age-dependent differences in coagulation parameters in this patient population.
Main Methods:
- A prospective observational study included 49 children under 24 months undergoing cardiac surgery with CPB.
- Coagulation was evaluated using standard assays, TEG, CAT, and PPL at anesthesia induction (T1) and 12 hours post-surgery (T2).
- Exclusion criteria included preoperative coagulopathy or anticoagulant therapy.
Main Results:
- Calibrated automated thrombogram (CAT) parameters (endogenous thrombin potential and peak height) were significantly lower in infants under 6 months at baseline.
- Standard coagulation tests, TEG, and PPL did not correlate with age.
- Post-surgery (T2), platelet count, fibrinogen, all TEG parameters, and CAT parameters were significantly impaired compared to baseline, despite blood product transfusions.
Conclusions:
- Thrombin generation is significantly impaired in children with congenital heart disease compared to healthy individuals.
- CAT parameters are age-dependent, with reduced thrombin generation in infants under 6 months.
- A post-CPB coagulopathy, detectable by CAT and TEG but not standard PT/aPTT, persists 12 hours after surgery despite transfusions.
Introduction:
Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB.
Materials And Methods:
Prospective observational study performed in children aged <24months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12h (T2). Perioperative bleeding management was performed according to the institutional guidelines.
Results:
Forty-nine children aged <24months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged <6months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions.
Conclusions:
Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged <6months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12h after surgery despite transfusions of blood products.
