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Thrombomodulin in pediatric cardiac surgery

J Boldt1, C Knothe, E Schindler

  • 1Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.

The Annals of Thoracic Surgery
|June 1, 1994
PubMed
Summary

Pediatric cardiac surgery impacts coagulation in children. Younger children (<10kg) show altered thrombomodulin and protein S levels, indicating potential thrombotic risks post-cardiopulmonary bypass.

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Area of Science:

  • Biochemistry
  • Pediatric Cardiology
  • Hematology

Background:

  • Congenital heart disease (CHD) necessitates complex surgical interventions.
  • Pediatric cardiac operations often involve cardiopulmonary bypass (CPB), a procedure known to affect hemostasis.
  • Understanding coagulation factor dynamics in children undergoing CPB is crucial for managing perioperative risks.

Purpose of the Study:

  • To investigate the impact of pediatric cardiac surgery and cardiopulmonary bypass on key coagulation factors in children.
  • To compare the levels of thrombomodulin, protein C, free protein S, and thrombin-antithrombin complex between children of different weight groups undergoing CPB.
  • To assess the postoperative recovery of these coagulation markers in relation to patient weight.

Main Methods:

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  • Prospective study of 30 children with CHD undergoing cardiac operations.
  • Measurement of thrombomodulin, protein C, free protein S, and thrombin-antithrombin complex using enzyme-linked immunosorbent assay.
  • Serial blood sampling at baseline, during, and after CPB until the first postoperative day.
  • Patients divided into two groups based on weight: <10 kg (Group 1) and >10 kg (Group 2).

    • Main Results:

    • Baseline thrombomodulin levels were significantly higher in smaller children (<10 kg) compared to larger children (>10 kg).
    • Cardiopulmonary bypass reduced thrombomodulin levels in both groups; however, levels remained elevated postoperatively only in the <10 kg group.
    • Protein C levels were below normal at baseline in all patients. Protein S levels were higher in smaller children but decreased significantly after CPB, with incomplete recovery in the <10 kg group.
    • Thrombin-antithrombin complex increased markedly at the end of CPB in both groups, returning to near-normal levels postoperatively.

    Conclusions:

    • Children weighing less than 10 kg exhibit distinct alterations in thrombomodulin and protein S levels during and after cardiopulmonary bypass.
    • These findings suggest a potential prothrombotic state in smaller children following CPB, warranting further investigation and clinical consideration.
    • Coagulation factor monitoring is essential in pediatric cardiac surgery, particularly in younger, smaller patients, to guide management and mitigate risks.