Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Geisinger Medical Center, 100 N Academy Avenue, Danville, PA, 17822, USA.
Pediatr Cardiol. 2022 Oct;43(7):1517-1521. doi: 10.1007/s00246-022-02877-1. Epub 2022 Mar 26.
Thrombosis, especially thrombosis of the pulmonary artery, is a large contributor to morbidity and mortality following comprehensive stage 2 procedure for single ventricle cardiac physiology. A peri-operative management protocol was implemented at our institution in March 2010. It includes 6 weeks of therapeutic anticoagulation post-operatively to mitigate the thrombotic risks in this patient population. This is a retrospective study of hospitalized children who received post-operative anticoagulation following a comprehensive stage 2 procedure for single ventricle cardiac physiology at a free-standing children's hospital. The primary objectives are to describe our institution's anticoagulation strategy and report on the number of thromboses and major bleeding episodes in the 6 weeks post-operatively. Secondary objectives include the dose of enoxaparin required to obtain a therapeutic low-molecular weight anti-factor-Xa (AFXaLMWH) level, and the number of patients outside of the therapeutic range. A total of 71 infants were included in the final analysis. Four patients experienced a thrombosis episode and three patients experienced clinically significant bleeding. The mean dose of enoxaparin required to obtain a therapeutic AFXaLMWH level between 0.5-1 unit/mL was 1.23 mg/kg SQ every 12 h and 37% of patients achieved goal AFXaLMWH levels with the initial starting dose of enoxaparin 1 mg/kg SQ every 12 h. We describe a 9-year experience of anticoagulation after single ventricle palliation. Anticoagulation with therapeutic AFXaLMWH goals of 0.5-1 unit/mL may reduce the rates of clinically significant thrombosis post-operatively in this population and appears safe without increase in significant bleeding episodes when compared to a historical cohort. Further studies comparing this population to those who do not receive post-operative anticoagulation are warranted.
血栓形成，尤其是肺动脉血栓形成，是单心室心脏生理学综合 2 期手术后发病率和死亡率的主要原因。我们机构于 2010 年 3 月实施了围手术期管理方案。它包括术后 6 周的治疗性抗凝，以降低该患者人群的血栓形成风险。这是一项回顾性研究，对象是在一家独立儿童医院接受单心室心脏生理学综合 2 期手术后接受术后抗凝治疗的住院儿童。主要目标是描述我们机构的抗凝策略，并报告术后 6 周内血栓形成和大出血事件的数量。次要目标包括获得治疗性低分子量抗因子-Xa（AFXaLMWH）水平所需的依诺肝素剂量，以及处于治疗范围之外的患者数量。共有 71 名婴儿最终纳入分析。4 名患者发生血栓形成事件，3 名患者发生临床显著出血。为达到 0.5-1 单位/mL 的治疗性 AFXaLMWH 水平，依诺肝素的平均剂量为 1.23mg/kg，每天皮下注射 12 次，37%的患者以依诺肝素初始起始剂量 1mg/kg，每天皮下注射 12 次达到目标 AFXaLMWH 水平。我们描述了单心室姑息术后 9 年抗凝经验。在该人群中，用治疗性 AFXaLMWH 目标值 0.5-1 单位/mL 进行抗凝治疗可能会降低术后临床显著血栓形成的发生率，与历史队列相比，似乎是安全的，不会增加明显的出血事件。需要进一步研究将该人群与未接受术后抗凝治疗的人群进行比较。
