Boucher Alexander A, Heneghan Julia A, Jang Subin, Spillane Kaitlyn A, Abarbanell Aaron M, Steiner Marie E, Meyer Andrew D
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States.
Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States.
Front Surg. 2022 Jun 14;9:907782. doi: 10.3389/fsurg.2022.907782. eCollection 2022.
Congenital heart disease encompasses a range of cardiac birth defects. Some defects require early and complex surgical intervention and post-operative thromboprophylaxis primarily for valve, conduit, and shunt patency. Antiplatelet and anticoagulant management strategies vary considerably and may or may not align with recognized consensus practice guidelines. In addition, newer anticoagulant agents are being increasingly used in children, but these medications are not addressed in most consensus statements. This narrative review evaluated the literature from 2011 through 2021 on the topic of postoperative thromboprophylaxis after congenital heart disease operations. The search was focused on the descriptions and results of pediatric studies for replacement and/or repair of heart valves, shunts, conduits, and other congenital heart disease operations. Wide variability in practice exists and, as was true a decade ago, few randomized controlled trials have been conducted. Aspirin, warfarin, and perioperative heparin remain the most commonly used agents with varying dosing, duration, and monitoring strategies, making comparisons difficult. Only recently have data on direct oral anticoagulants been published in children, suggesting evolving paradigms of care. Our findings highlight the need for more research to strengthen the evidence for standardized thromboprophylaxis strategies.
先天性心脏病涵盖一系列心脏出生缺陷。一些缺陷需要早期且复杂的手术干预以及术后血栓预防，主要用于瓣膜、管道和分流的通畅。抗血小板和抗凝管理策略差异很大，可能与公认的共识实践指南一致，也可能不一致。此外，新型抗凝药物在儿童中越来越多地被使用，但大多数共识声明中并未涉及这些药物。本叙述性综述评估了2011年至2021年期间关于先天性心脏病手术后血栓预防主题的文献。搜索重点是儿科研究中关于心脏瓣膜置换和/或修复、分流、管道以及其他先天性心脏病手术的描述和结果。实践中存在很大差异，而且和十年前一样，很少有随机对照试验。阿司匹林、华法林和围手术期肝素仍然是最常用的药物，其给药剂量、持续时间和监测策略各不相同，难以进行比较。直到最近才有关于儿童直接口服抗凝剂的数据发表，这表明护理模式在不断演变。我们的研究结果强调需要更多研究来加强标准化血栓预防策略的证据。
