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Peri-operative Anticoagulation Strategies, Bleeding and Thrombotic Complications in Pediatric Patients Undergoing
Abraham Haimed1, Katherine A Brandt1, Sherif Badawy2
1Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Peri-operative anticoagulation for congenital portosystemic shunts (CPSS) requires careful management. This study found both thrombotic and bleeding complications occurred post-closure in CPSS patients.
Area of Science:
- Vascular Surgery
- Hepatology
- Pediatric Surgery
Background:
- Congenital portosystemic shunts (CPSS) are rare vascular anomalies.
- Abnormal portal and systemic circulation occurs in CPSS.
- This study focuses on anticoagulation management post-CPSS closure.
Purpose of the Study:
- To evaluate peri-operative anticoagulation strategies for CPSS.
- To determine the incidence of thrombotic and bleeding complications after CPSS closure.
Main Methods:
- Single-center retrospective analysis (2005-2021).
- Included patients undergoing surgery or endovascular intervention for CPSS.
- Assessed outcomes including thrombotic and bleeding complications.
Main Results:
- 44 CPSS patients analyzed.
- Postoperative anticoagulation involved unfractionated heparin (UFH), warfarin, or low molecular weight heparin (LMWH).
- 16% experienced thrombotic complications; 64% experienced bleeding complications. No deaths reported.
Conclusions:
- Anticoagulation management for CPSS patients presents a balance between thrombotic and bleeding risks.
- Postoperative complications are common after CPSS closure.
Background:
Congenital portosystemic shunts (CPSS) are rare congenital abnormalities causing abnormal blood flow between the portal vein and systemic circulation. This study reports on the peri-operative anticoagulation management of CPSS patients post closure, focusing on the incidence of thrombotic and bleeding complications.
Methods:
This is a single-center retrospective analysis of CPSS patients who underwent surgery or endovascular intervention between 2005 and 2021. The protocol included unfractionated heparin (UFH) during and immediately after surgery, followed by either warfarin or low molecular weight heparin (LMWH) postoperatively. Outcomes assessed included postoperative thrombotic and bleeding complications.
Results:
A total of 44 patients were included. Postoperatively, 89% received treatment-dose UFH, transitioning to warfarin or LMWH at discharge. Thrombotic complications occurred in 16% of patients, predominantly in the superior mesenteric vein. Surgical interventions and continuous infusion of tissue plasminogen activator (tPA) were used for clot resolution. Bleeding complications were observed in 64% of patients, primarily managed with transfusions and temporary UFH interruption. No deaths related to thrombotic, or bleeding events were reported.
Conclusions:
Our findings underscore the delicate balance required in anticoagulation management for CPSS patients, revealing an occurrence of both thrombotic and bleeding complications postoperatively.
Levels Of Evidence:
Level II, retrospective study.
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