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Perioperative Transfusion Requirements in Pediatric Patients Receiving Apixaban Prior to Cardiac Surgery With
Mckenna M Longacre1, Christina J VanderPlyum2, Steven J Staffa1
1Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
Recent apixaban use in pediatric cardiac surgery patients was linked to more intraoperative red blood cell salvage transfusions. However, overall perioperative transfusion needs did not significantly increase, even in urgent cases.
Area of Science:
- Cardiology
- Hematology
- Pediatric Surgery
Background:
- Apixaban is a direct oral anticoagulant targeting factor Xa.
- Perioperative transfusion management is critical in pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the impact of recent apixaban use on perioperative transfusion requirements.
- To assess transfusion needs in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
Main Methods:
- Retrospective review of pediatric patients (2021-2023) who received apixaban before cardiac surgery.
- Comparison of 43 apixaban patients with 172 propensity-matched controls.
- Analysis of intraoperative and postoperative transfusion volumes and outcomes.
Main Results:
- Apixaban patients received more intraoperative red cell salvage (20.6 vs 12.9 mL/kg, p=0.041).
- No significant difference in nonautologous blood product transfusions intraoperatively.
- Increased packed red blood cells and fresh-frozen plasma transfusions postoperatively in apixaban group.
Conclusions:
- Recent apixaban use is associated with increased intraoperative red cell salvage.
- Apixaban does not significantly increase overall perioperative transfusion requirements in pediatric cardiac surgery patients.
Design:
Apixaban is a direct oral anticoagulant that inhibits factor Xa. Our objective was to examine the effect of apixaban on perioperative transfusion requirements in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
Setting:
Quaternary children's hospital.
Participants:
Children with congenital or acquired heart disease who received apixaban less than 3 days prior to a cardiac surgical procedure on cardiopulmonary bypass from 2021 to 2023.
Interventions:
A retrospective review.
Measurements And Main Results:
Forty-three patients with recent apixaban use (median = 2 doses held) were compared to 172 propensity-matched controls. In the entire cohort, 81% of procedures were urgent or emergent, and 30% were reoperative sternotomies. Patients on apixaban received a greater volume of red cell salvage intraoperatively (20.6 v 12.9 mL/kg, p = 0.041). There was no significant difference in the volume of nonautologous blood products transfused intraoperatively between the 2 groups. In the first 24 hours postoperatively, more apixaban patients received a transfusion of packed red blood cells and fresh-frozen plasma. Between the 2 groups, there was no statistically significant difference in the rate of emergent reexploration after the surgery or death within 7 days of operation.
Conclusion:
Recent apixaban use in children undergoing cardiac surgery was associated with increased intraoperative transfusion of salvaged red cells. The recent use of apixaban does not appreciably increase the perioperative transfusion requirements of pediatric patients undergoing cardiac surgery, including those undergoing emergent procedures.
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