Vol. 25 No. 1 (2021)
ANESTHESIOLOGY & RESUSCITATION

Effectiveness of antithrombotic prophylaxis in paediatric cardiosurgical patients

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  • N.B. Karakhalis
N.B. Karakhalis
Research Institute – S.V. Ochapovsky Regional Clinic Hospital No. 1, Ministry of Health of Krasnodar Region, Krasnodar
Bio
DOI: https://doi.org/10.21688/1681-3472-2021-1-97-106

Published 2021-04-02

Keywords

  • antithrombotic prophylaxis,
  • congenital heart disease,
  • perioperative period,
  • thrombosis

How to Cite

Karakhalis, N. (2021). Effectiveness of antithrombotic prophylaxis in paediatric cardiosurgical patients. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 25(1), 97–106. https://doi.org/10.21688/1681-3472-2021-1-97-106

Copyright (c) 2021 Karakhalis N.B.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. To evaluate the effectiveness of prevention measures for thrombotic catheter-associated events in the perioperative management of patients undergoing cardiac surgery.
Methods. A total of 433 paediatric and neonatal patients were included in the study during the period from January to December 2018. All patients received antithrombotic prophylaxis via systemic heparin administration.
Results. Thirty-six patients displayed signs of thrombosis during the postoperative period (8.31%): 28 patients had venous thrombosis, while 6 had the Blalock-Taussig shunt thrombosis, and 2 had arterial thrombosis. The mortality rate was higher in the group with registered thrombosis than in the group without thrombosis (p = 0.01).
Conclusion. The dosage regimen for children and neonatal patients should be according to age-associated antithrombotic drug standards. It requires an integral approach for evaluating the effectiveness of preventive and therapeutic measures.

Received 25 August 2020. Revised 18 December 2020. Accepted 22 December 2020.

Funding: The study did not have sponsorship.

Conflict of interest: Author declares no conflict of interest.

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References

  1. Young G., Male C., van Ommen C.H. Anticoagulation in children: making the most of little patients and little evidence. Blood Cells Mol Dis. 2017;67:48-53. PMID: 28552476. https://doi.org/10.1016/j.bcmd.2017.05.003
  2. Карахалис Н.Б., Ефимочкин Г.А., Шадрин А.К., Синьков С.В. Антитромботическая терапия у детей. Анестезиология и реаниматология. 2018;63(1):46-55. [Karakhalis N.B., Efimochkin G.A., Shadrin A.K., Sinkov S.V. Antithrombotic therapy in children. Russian Journal of Anаеsthesiology and Reanimatology = Anesteziologiya i reanimatologiya. 2018;63(1):46-55. (In Russ.)] https://doi.org/10.18821/0201-7563-2018-63-1-46-55
  3. Hrdy O., Strazevska E., Suk P., Vach R., Karlik R., Jarkovsky J., Sas I., Gal R. Central venous catheter-related thrombosis in intensive care patients – incidence and risk factors: a prospective observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161(4):369-373. PMID: 28839334. https://doi.org/10.5507/bp.2017.034
  4. Menéndez J.J., Verdú C., Calderón B., Gómez-Zamora A., Schüffelmann C., de la Cruz J.J., de la Oliva P. Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost. 2016;14(11):2158-2168. PMID: 27558946. https://doi.org/10.1111/jth.13478
  5. Chopra V., Kaatz S., Conlon A., Paje D., Grant P.J., Rogers M.A.M., Bernstein S.J., Saint S., Flanders S.A. The Michigan risk score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost. 2017;15(10):1951-1962. PMID: 28796444. https://doi.org/10.1111/jth.13794
  6. Kim J., Sun Z., Benrashid E., Southerland K.W., Lawson J.H., Fleming G.A., Hill K.D., Tracy E.T. The impact of femoral arterial thrombosis in paediatric cardiac catheterisation: a national study. Cardiol Young. 2017;27(5):912-917. PMID: 27821192. https://doi.org/10.1017/S104795111600161X
  7. Vidovich M.I. Ulnar artery catheterization: is this our second access site or is it still femoral? Curr Cardiol Rep. 2018;20(10):91. PMID: 30128754. https://doi.org/10.1007/s11886-018-1039-y
  8. Biss T.T. Venous thromboembolism in children: is it preventable? Semin Thromb Hemost. 2016;42(6):603-611. PMID: 27272961. https://doi.org/10.1055/s-0036-1581100
  9. Bacciedoni V., Attie M., Donato H., Comité Nacional de Hematología, Oncología y Medicina Transfusional. Thrombosis in newborn infants. Arch Argent Pediatr. 2016;114(2):159-166. PMID: 27079395. https://doi.org/10.5546/aap.2016.eng.159
  10. Onyeama S.-J.N., Hanson S.J., Dasgupta M., Hoffmann R.G., Faustino E.V.S., Prophylaxis against Thrombosis Practice Study Investigators. Factors associated with continuous low-dose heparin infusion for central venous catheter patency in critically ill children worldwide. Pediatr Crit Care Med. 2016;17(8):e352-e361. PMID: 27362853, PMCID: PMC4980163. https://doi.org/10.1097/PCC.0000000000000854
  11. Park C.K., Paes B.A., Nagel K., Chan A.K., Murthy P., Thrombosis and Hemostasis in Newborns (THiN) Group. Neonatal central venous catheter thrombosis: diagnosis, management and outcome. Blood Coagul Fibrinolysis. 2014;25(2):97-106. PMID: 24477225. https://doi.org/10.1097/MBC.0b013e328364f9b0
  12. Emani S., Zurakowski D., Baird C.W., Pigula F.A., Trenor C. 3rd, Emani S.M. Hypercoagulability panel testing predicts thrombosis in neonates undergoing cardiac surgery. Am J Hematol. 2014;89(2):151-155. PMID: 24123221. https://doi.org/10.1002/ajh.23607
  13. Walker I.D. Blood collection and sample preparation: pre- analytical variation. In: Jespersen J., Bertina R.M., Haverkate F., editors. Laboratory techniques in thrombosis – A manual. 2nd revised edition of ECAT assay procedures. Dordrecht: Kluwer Academic Publ., 1999. p. 21-28. https://doi.org/10.1007/978-94-011-4722-4_3
  14. Polack B., Schved J.F., Boneu B., Groupe d’Etude sur l’Hémostase et la Thrombose’ (GEHT). Preanalytical recommendations of the ‘Groupe d’Etude sur l’Hémostase et la Thrombose’ (GEHT) for venous blood testing in hemostasis laboratories. Haemostasis. 2001;31(1):61-68. PMID: 11408751. https://doi.org/10.1159/000048046
  15. Guidelines for thromboplastin and plasma used to control oral anticoagulant therapy. WHO Technical Report series. Annex 3. 1999. No. 889. Available from: https://www.who.int/bloodproducts/publications/WHO_TRS_889_A3.pdf
  16. Sol J.J., Knoester H., de Neef M., Smets A.M., Betlem A., van Ommen C.H. Chronic complications after femoral central venous catheter-related thrombosis in critically ill children. J Pediatr Hematol Oncol. 2015;37(6):462-467. PMID: 26056799. https://doi.org/10.1097/MPH.0000000000000370
  17. Jones S., Butt W., Monagle P., Cain T., Newall F. The natural history of asymptomatic central venous catheter-related thrombosis in critically ill children. Blood. 2019;133(8):857-866. PMID: 30377196. https://doi.org/10.1182/blood-2018-05-849737
  18. Vitanova K., Leopold C., von Ohain J.P., Wolf C., Beran E., Lange R., Cleuziou J. Reasons for failure of systemic-to-pulmonary artery shunts in neonates. Thorac Cardiovasc Surg. 2019;67(1):2-7. PMID: 29351695. https://doi.org/10.1055/s-0037-1621706
  19. Vitanova K., Leopold C., Pabst von Ohain J., Wolf C., Beran E., Lange R., Cleuziou J. Risk factors for failure of systemic-to-pulmonary artery shunts in biventricular circulation. Pediatr Cardiol. 2018;39(7):1323-1329. PMID: 29756161. https://doi.org/10.1007/s00246-018-1898-4
  20. Kiran U., Aggarwal S., Choudhary A., Uma B., Kapoor P.M. The Blalock and Taussig Shunt Revisited. Ann Card Anaesth. 2017;20(3):323-330. PMID: 28701598, PMCID: PMC5535574. https://doi.org/10.4103/aca.ACA_80_17
  21. Chen G., Shi W., He X., Lou W., Chen L., Gu J. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding. Exp Ther Med. 2017;13(2):751-758. PMID: 28352362, PMCID: PMC5348685. https://doi.org/10.3892/etm.2017.4023
  22. Dinh C.N., Moffett B.S., Galati M., Lee-Kim Y., Yee D.L., Mahoney D. A critical evaluation of enoxaparin dose adjustment guidelines in children. J Pediatr Pharmacol Ther. 2019;24(2):128-133. PMID: 31019405, PMCID: PMC6478360. https://doi.org/10.5863/1551-6776-24.2.128