Soderstrom Rhynn J, Chernuta Elizabeth C, Chaudhry-Waterman Nadia, Rafter Jennifer A, Stone Matthew L, Kim John S
Department of Pharmacy, Children's Hospital Colorado, Aurora, Colo.
Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
JTCVS Tech. 2025 Feb 28;31:152-157. doi: 10.1016/j.xjtc.2025.02.006. eCollection 2025 Jun.
We aim to describe the successful use of bivalirudin for immediate postoperative aortopulmonary shunt thrombosis prevention. This article also describes the details of an institutional protocol for postoperative aortopulmonary shunt thrombosis prevention. In addition, we demonstrate the safe and effective use of low-molecular-weight heparin and aspirin for interstage thrombosis prevention.
Retrospective cohort study of neonates (excluding infants younger than age 1 day and older than age 28 days) undergoing stage 1 single-ventricle palliation with either a modified Blalock Taussig Thomas or central shunt over a 2-year period.
Eighteen consecutive neonates were studied, 11 patients after modified Blalock Taussig Thomas shunt and 7 after central shunt. All patients were initiated on bivalirudin infusion of 0.2 mg/kg/h. Patients remained within the target partial thromboplastin time range of 50 to 70 seconds a median of 97% of the time. None of the 18 patients had shunt thrombosis during the first 21 days after surgery. There were 2 patients who experienced late shunt thrombosis (61 and 27 days), prompting the addition of low-molecular-weight heparin to aspirin after transition from bivalirudin. With low-molecular-weight heparin and aspirin, there were no further shunt thromboses and all patients survived to second-stage surgery.
Bivalirudin is a safe and effective alternative to unfractionated heparin for immediate postoperative aortopulmonary shunt thrombosis prevention. Transition to low-molecular-weight heparin and aspirin resulted in effective and safe thrombosis prevention through the second-stage surgery. This regimen resulted in no bleeding complications in this cohort of 18 infants.
我们旨在描述比伐芦定在预防术后即刻体肺分流血栓形成方面的成功应用。本文还描述了术后体肺分流血栓形成预防的机构方案细节。此外，我们展示了低分子量肝素和阿司匹林在预防分期手术期间血栓形成方面的安全有效应用。
对在2年期间接受改良布莱洛克-陶西格-托马斯分流术或中心分流术进行一期单心室姑息治疗的新生儿（不包括出生1天以内和28天以上的婴儿）进行回顾性队列研究。
连续研究了18例新生儿，11例接受改良布莱洛克-陶西格-托马斯分流术，7例接受中心分流术。所有患者均开始静脉输注比伐芦定，剂量为0.2mg/kg/h。患者部分凝血活酶时间保持在50至70秒的目标范围内，中位数时间为97%。18例患者在术后前21天均未发生分流血栓形成。有2例患者发生了晚期分流血栓形成（分别在术后61天和27天），促使在从比伐芦定过渡后加用低分子量肝素和阿司匹林。使用低分子量肝素和阿司匹林后，未再发生分流血栓形成，所有患者均存活至二期手术。
比伐芦定是预防术后即刻体肺分流血栓形成的一种安全有效的普通肝素替代药物。过渡到低分子量肝素和阿司匹林可在二期手术前有效预防血栓形成且安全。在这18例婴儿队列中，该方案未导致出血并发症。
