Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Cardiac Anesthesia/Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165 Roma, Italy.
Department of Laboratory Medicine, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165 Roma, Italy.
Thromb Res. 2017 Dec;160:91-96. doi: 10.1016/j.thromres.2017.09.021. Epub 2017 Sep 21.
Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB.
Prospective observational study performed in children aged <24months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12h (T2). Perioperative bleeding management was performed according to the institutional guidelines.
Forty-nine children aged <24months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged <6months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions.
Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged <6months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12h after surgery despite transfusions of blood products.
在体外循环（CPB）心脏手术后，凝血酶生成受损与出血增加有关，尤其是在儿童中。本研究的目的是评估标准凝血检测、校准自动血栓图（CAT）的凝血酶生成、血栓弹力图（TEG）和促凝血磷脂（PPL）活性在接受 CPB 心脏手术的婴儿中的应用。
前瞻性观察研究在接受 CPB 心脏手术的 <24 个月龄儿童中进行。排除标准为术前凝血异常或抗凝治疗。在麻醉诱导（T1）和 12 小时后（T2）时，通过标准凝血检测（凝血酶原时间、激活部分凝血活酶时间、纤维蛋白原水平、血小板计数）、TEG、CAT 和 PPL 评估凝血。根据机构指南进行围手术期出血管理。
共纳入 49 名 <24 个月龄的儿童。在 T1 时，CAT 评估的 ETP 和峰高在 <6 个月龄的婴儿中明显较低。标准凝血试验、TEG 和 PPL 与年龄无关。在 T2 时，与基线值（T1）相比，血小板计数、血浆纤维蛋白原水平、所有 TEG 参数、CAT 的 ETP 和峰高均显著降低，尽管输注了同种异体血液制品。
与健康儿童和成人相比，患有先天性心脏病的儿童凝血酶生成明显受损。CAT 参数随年龄而变化，且 <6 个月龄的婴儿凝血酶生成较低。在 CPB 心脏手术后，尽管输注了血液制品，但 CAT、TEG 揭示的凝血功能障碍在手术后 12 小时仍然持续存在，而 PT 和 aPTT 检测则没有。
