Non-Surgical Related Bleeding in Pediatric Patients with Single Ventricle Physiology Following Cardiac Surgery

Introduction: Pediatric patients with Single Ventricle Physiology (SVP) show numerous different risk factors leading to an increased risk for both bleeding and thrombosis during the immediate postoperative period following cardiac surgery (Giglia, Massicotte et al. 2013). Therefore, adequate anticoagulation therapy in these patients is essential. However, recommendations for frequently used medications and monitoring parameters are mostly derived from adult guidelines and little data on non-surgical related bleeding exists. The aim of this study was to identify possible risk factors for bleeding possibly related to anticoagulation in pediatric patients with SVP on the cardiac intensive care unit (CICU). Methods: Patients with SVP admitted to the CICU after open heart surgery at Boston Children’s Hospital were studied and reviewed regarding bleeding outcomes remote from surgery and independent of interventional procedures. Demographic and clinical characteristics as well as medications and laboratory values were compared between bleeding and non-bleeding patients. Significantly associated variables with bleeding in univariate analyses were included in a multivariate binary logistic regression model to identify independent associations. Results: Among 266 patients undergoing cardiac surgery at BCH, 49 bleeding patients were identified. High dose unfractionated heparin (UFH) of ≥15 u/hr/kg, platelet counts of <160,500/l and no administration of Aspirin were significantly associated with bleeding. Commonly used anticoagulation monitoring assays like activated partial thromboplastin time (aPTT), Anti-factor Xa activity and international normalized ratio (INR) on the other hand, showed no associations with bleeding in this study. Using thromboelastography, adequate fibrinogen and platelet function in SVP were demonstrated. Conclusion: This study extended previous research on anticoagulation therapy in pediatric patients with SVP. It increases existing doubts about the safety of high dose UFH in pediatric patients with SVP on the CICU. Furthermore, future studies on the evaluation of platelet transfusion triggers are needed and might be able to help reduce extensive hemorrhage in SV patients.

Collections

Dissertationen/Habilitationen

Full item page

Non-Surgical Related Bleeding in Pediatric Patients with Single Ventricle Physiology Following Cardiac Surgery

Files

Date

Authors

Advisors/Reviewers

Further Contributors

Contributing Institutions

Publisher

Journal Title

Journal ISSN

Volume Title

Publisher

License

Quotable link

Abstract

Link to publications or other datasets

Description

Notes

Original publication in

Original publication in

Anthology

Collections

URI of original publication

Forschungsdaten

Series

Citation