Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Division of Perfusion and Extracorporeal Life Support, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
J Cardiothorac Vasc Anesth. 2020 Feb;34(2):349-355. doi: 10.1053/j.jvca.2019.07.123. Epub 2019 Jul 13.
Children with congenital heart defects are at increased risk for perioperative bleeding and postoperative thrombosis. In this study, the authors sought to develop a predictive model for postoperative thrombotic complications that integrates intraoperative bleeding and the requirement for allogenic blood products in addition to known patient and surgical characteristics.
Retrospective cohort.
Pediatric hospital.
Neonates and children who underwent surgery with cardiopulmonary bypass (CPB).
None MEASUREMENTS AND MAIN RESULTS: Demographic, laboratory, point-of-care coagulation, surgical, and perioperative transfusion data were collected. Among the 369 participants included in the study, 67 (18%) developed postoperative thrombotic complications. From multivariable logistic regression analyses, preoperative oxygen saturation <85% (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.10-3.85; p = 0.024), surgery in the neonatal period (OR 2.16, 95% CI 1.02-4.55; p = 0.044), use of preoperative antiplatelet or anticoagulation therapy (OR 3.34, 95% CI 1.61-6.96; p = 0.001), and the volume of blood product transfused post-CPB (>80 mL/kg [OR 5.72, 95% CI 1.73-18.91; p = 0.004] and 15-80 mL/kg [OR 3.06, 95% CI 1.24-7.53; p = 0.015]) were independently associated with an increased incidence of thrombotic complications. No statistical differences were observed in available preoperative coagulation tests between children who developed postoperative thrombosis and those who did not.
This observational cohort study found that cyanosis, surgery in neonates, preoperative anticoagulation or antiplatelet therapy, and the volume of post-CPB transfusion are important predictors of postoperative thrombotic complications in children undergoing cardiac surgery. Additional studies are required to explore the relationship between hypoxia, coagulopathy, and postoperative thrombosis.
患有先天性心脏缺陷的儿童在围手术期出血和术后血栓形成方面风险增加。本研究旨在建立一种预测术后血栓并发症的模型，该模型将术中出血和异体血液制品的需求与已知的患者和手术特征相结合。
回顾性队列研究。
儿科医院。
接受体外循环（CPB）手术的新生儿和儿童。
无。
收集了人口统计学、实验室、即时凝血、手术和围手术期输血数据。在纳入的 369 名研究参与者中，有 67 名（18%）发生术后血栓并发症。多变量逻辑回归分析显示，术前氧饱和度<85%（比值比[OR]2.06，95%置信区间[CI]1.10-3.85；p=0.024）、新生儿期手术（OR 2.16，95%CI 1.02-4.55；p=0.044）、术前使用抗血小板或抗凝治疗（OR 3.34，95%CI 1.61-6.96；p=0.001）和 CPB 后输血量（>80mL/kg[OR 5.72，95%CI 1.73-18.91；p=0.004]和 15-80mL/kg[OR 3.06，95%CI 1.24-7.53；p=0.015]）与血栓并发症发生率增加独立相关。在发生术后血栓形成和未发生血栓形成的儿童之间，术前可用凝血试验无统计学差异。
本观察性队列研究发现，发绀、新生儿期手术、术前抗凝或抗血小板治疗以及 CPB 后输血量是儿童心脏手术后发生术后血栓并发症的重要预测因素。需要进一步研究来探讨缺氧、凝血障碍和术后血栓形成之间的关系。
