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Prothrombotic Microvesicle Generation in Pediatric Cardiopulmonary Bypass: A Pilot Observational Study
Andrew D Meyer1,2, Anjana Rishmawi1, Alia Elkhalili1
1Division of Critical Care, Department of Pediatrics, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX.
Critical Care Explorations
|March 31, 2025
Summary
Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) show increased prothrombotic microvesicles (MVs). Single ventricle physiology is linked to higher MV levels and thrombin generation, indicating potential thrombosis risk.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hemostasis and Thrombosis
Background:
- Thrombosis complicates over 10% of pediatric cardiac surgeries, particularly in single ventricle patients, leading to adverse outcomes.
- Understanding mechanisms of cardiopulmonary bypass (CPB)-induced thrombin generation is crucial for reducing complications.
Purpose of the Study:
- To measure prothrombotic microvesicle (MV) generation and thrombin generation in children undergoing CPB surgery.
- To compare MV and thrombin generation between single ventricle and dual ventricle pediatric patients.
Main Methods:
- Pilot observational study in 21 children (birth to 5 years) undergoing CPB surgery.
- Measured platelet and leukocyte MVs, platelet aggregation, coagulation, and thrombin generation at multiple time points.
- Assessed bleeding via chest tube output and thrombosis via ultrasound.
Main Results:
- CPB duration correlated with increased white blood cells (WBCs) and phosphatidylserine-expressing MVs.
- Single ventricle patients exhibited higher prothrombotic MVs, platelet aggregation, peak thrombin, and d-dimer compared to dual ventricle patients.
- A positive correlation between platelet MV generation and peak thrombin was observed exclusively in single ventricle children.
Conclusions:
- Children with single ventricle physiology show elevated prothrombotic markers post-CPB.
- Prothrombotic MVs may serve as predictive markers for thrombotic events in pediatric congenital heart disease.
- Further large-scale prospective studies are warranted to validate these findings.
