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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease
Lee D Murphy1, Brian D Benneyworth1, Elizabeth A S Moser2
1Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Insights
Pediatric cardiac surgery patients experienced a 6.2% thrombosis rate. Fresh frozen plasma exposure was linked to increased thrombosis risk, while low molecular weight heparin showed no significant preventive effect.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Hematology
Background:
- Thrombosis is a significant complication in pediatric cardiac surgery, affecting 4-15% of patients.
- Effective preventative strategies for thrombosis in this population are lacking.
Purpose of the Study:
- To identify risk factors for thrombosis after pediatric cardiac surgery.
- To evaluate the efficacy of low molecular weight heparin prophylaxis in reducing thrombosis risk.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing cardiac surgery.
- Matched case-control analysis comparing patients with and without thrombosis.
- Multivariate analysis to identify independent risk factors.
Main Results:
- Thrombosis occurred in 6.2% of patients, with venous thromboses being most common (76%).
- Fresh frozen plasma exposure was independently associated with an increased risk of thrombosis (OR, 3.7).
- Low molecular weight heparin prophylaxis use did not show a statistically significant difference between thrombotic and non-thrombotic groups.
Conclusions:
- The incidence of thrombosis post-pediatric cardiac surgery is comparable to previous reports.
- Fresh frozen plasma may be a significant risk factor for thrombosis in this cohort.
- Further research is required to clarify the role of low molecular weight heparin in thromboprophylaxis and the association with fresh frozen plasma.
Objectives:
Thrombosis is a cause of morbidity in 4-15% of children who undergo pediatric cardiac surgery. Data on how to prevent this complication are sorely needed. We aimed to identify risk factors for thrombosis following pediatric cardiac surgery and determine if use of low molecular weight heparin prophylaxis is associated with a reduction in thrombosis risk.
Design:
Retrospective cohort study.
Setting:
Tertiary pediatric cardiovascular ICU.
Patients:
Patients who underwent cardiac surgery between June 2014 and December 2015.
Interventions:
None.
Measurements And Main Results:
Data from patients with venous or arterial thrombosis confirmed by radiologic studies were matched two-to-one to controls based on age, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, and gender. Thrombosis was detected in 33 patients (6.2%): 25 patients (76%) had venous thromboses, five patients (15%) had arterial thromboses, and three patients (9%) had both. Median time to thrombosis detection was 13 days (25-75%; 7-31 d). On multivariate analysis, which included adjustment for postoperative disease severity, fresh frozen plasma exposure was independently associated with thrombosis (odds ratio, 3.7; 95% CI, 1.4-9.4). Twenty-eight patients (85%) had central venous catheter-related thromboses. Low molecular weight heparin prophylaxis use in this subset of patients was not statistically different from controls (50% vs 45%, respectively; p = 0.47). On multivariable analysis, fresh frozen plasma exposure was also independently associated with central venous catheter-related thrombosis (odds ratio, 3.6; 95% CI, 1.2-10.6).
Conclusions:
The occurrence of thrombosis after pediatric cardiac surgery at our institution was 6.2%, similar to what has been reported in other studies, despite frequent use of low molecular weight heparin. Further study is needed to determine the role of low molecular weight heparin for thromboprophylaxis and the relationship between fresh frozen plasma and thrombosis risk in children who undergo cardiac surgery.
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