Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2019 Oct;158(4):1199-1206. doi: 10.1016/j.jtcvs.2019.06.015. Epub 2019 Jun 15.
To determine the association between unfractionated heparin (UFH) dose and the rate of postoperative bleeding and thrombosis events in pediatric cardiac patients. We tested the hypothesis that high-dose UFH is associated with higher rates of bleeding and thrombosis.
This is a retrospective review of pediatric patients admitted to the cardiac intensive care unit following cardiac surgery between November 2016 and December 2017. Peripheral venous thrombosis was excluded from analysis. Bleeding was defined as spontaneous bleeding remote from procedural manipulation. Postoperative UFH dosing strategy was categorized into 3 groups: no UFH, low-dose UFH (<15 U/kg/h) and high-dose UFH (≥15 U/kg/h). Statistical analysis was performed using multivariable logistic regression.
We observed 966 consecutive patients (median age, 1.37 years; interquartile range, 0.27-5.50 years) during their stay in the cardiac intensive care unit. There were 94 patients (10%) with bleeding and 52 patients (5%) with thrombosis during follow-up. Patients receiving high-dose UFH experienced significantly more bleeding (odds ratio, 2.35; 95% confidence interval, 1.45-3.95) and thrombosis events (odds ratio, 3.65; 95% confidence interval, 1.81-7.38) compared with patients receiving low-dose UFH. The odds of bleeding (odds ratio, 0.81; 95% confidence interval, 0.45-1.47) and thrombosis (odds ratio, 0.59; 95% confidence interval, 0.26-1.35) were similar in the low-dose UFH and no-UFH groups.
Bleeding remote from immediate postsurgical bleeding occurs uncommonly in pediatric patients following cardiac surgery. Anticoagulation with high-dose UFH is associated with higher bleeding rates as well as higher thrombosis rates. Indications for high-dose UFH should be carefully considered to reduce the rate of bleeding in this population.
确定未分级肝素（UFH）剂量与儿科心脏患者术后出血和血栓形成事件发生率之间的关系。我们检验了以下假设，即高剂量 UFH 与更高的出血和血栓形成率相关。
这是一项回顾性研究，纳入了 2016 年 11 月至 2017 年 12 月期间在心脏重症监护病房接受心脏手术后的儿科患者。外周静脉血栓形成被排除在分析之外。出血定义为远离手术操作的自发性出血。术后 UFH 给药策略分为 3 组：无 UFH、低剂量 UFH（<15 U/kg/h）和高剂量 UFH（≥15 U/kg/h）。使用多变量逻辑回归进行统计分析。
我们观察了 966 例连续患者（中位数年龄为 1.37 岁；四分位距为 0.27-5.50 岁）在心脏重症监护病房的住院期间。在随访期间，有 94 例（10%）患者发生出血，52 例（5%）患者发生血栓形成。与接受低剂量 UFH 的患者相比，接受高剂量 UFH 的患者发生出血（优势比，2.35；95%置信区间，1.45-3.95）和血栓形成事件（优势比，3.65；95%置信区间，1.81-7.38）的风险显著更高。与接受低剂量 UFH 的患者相比，低剂量 UFH 和无 UFH 组的出血（优势比，0.81；95%置信区间，0.45-1.47）和血栓形成（优势比，0.59；95%置信区间，0.26-1.35）的可能性相似。
心脏手术后，儿科患者在远离术后即时出血的部位发生出血的情况并不常见。抗凝治疗使用高剂量 UFH 与更高的出血率以及更高的血栓形成率相关。应仔细考虑高剂量 UFH 的适应证，以降低该人群的出血率。
