Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease

Abstract

Objectives: Thrombosis is a cause of morbidity in 4–15% of children who undergo pediatric cardiac surgery. Data on how to prevent this complication are sorely needed. We aimed to identify risk factors for thrombosis following pediatric cardiac surgery and determine if use of low molecular weight heparin prophylaxis is associated with a reduction in thrombosis risk. Design: Retrospective cohort study. Setting: Tertiary pediatric cardiovascular ICU. Patients: Patients who underwent cardiac surgery between June 2014 and December 2015. Interventions: None. Measurements and Main Results: Data from patients with venous or arterial thrombosis confirmed by radiologic studies were matched two-to-one to controls based on age, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, and gender. Thrombosis was detected in 33 patients (6.2%): 25 patients (76%) had venous thromboses, five patients (15%) had arterial thromboses, and three patients (9%) had both. Median time to thrombosis detection was 13 days (25–75%; 7–31 d). On multivariate analysis, which included adjustment for postoperative disease severity, fresh frozen plasma exposure was independently associated with thrombosis (odds ratio, 3.7; 95% CI, 1.4–9.4). Twenty-eight patients (85%) had central venous catheter-related thromboses. Low molecular weight heparin prophylaxis use in this subset of patients was not statistically different from controls (50% vs 45%, respectively; p = 0.47). On multivariable analysis, fresh frozen plasma exposure was also independently associated with central venous catheter-related thrombosis (odds ratio, 3.6; 95% CI, 1.2–10.6). Conclusions: The occurrence of thrombosis after pediatric cardiac surgery at our institution was 6.2%, similar to what has been reported in other studies, despite frequent use of low molecular weight heparin. Further study is needed to determine the role of low molecular weight heparin for thromboprophylaxis and the relationship between fresh frozen plasma and thrombosis risk in children who undergo cardiac surgery.

Upper body peripherally inserted central catheter in pediatric single ventricle patients

“…There is a large range of reported incidence of venous thrombosis after cardiac surgery in the literature. A prior study from our institute identified a rate of thrombosis of 6% among all patients who underwent cardiac surgery which similar is to this cohort[ 1 ]. Manlhiot et al[ 2 ], reported thrombosis in 11% of pediatric patients with CHD[ 2 ].…”

“…Children with critical congenital heart disease (CHD) often require a central venous catheter (CVC) in the medication administration, fluid resuscitation, nutrition and hemodynamic monitoring prior to surgical repair and for post-operative care management. A subset of children with CHD can require central venous access for a longer period of time[ 1 , 2 ]. The use of central venous catheters (CVCs) or percutaneously inserted central catheters (PICCs) for prolonged periods can result in complications including venous stenosis and thrombosis, especially in neonates[ 3 , 4 ].…”

“…Central venous thrombosis is a cause of considerable morbidity and mortality in children who undergo surgery for CHD[ 5 , 6 ]. Patients who undergo surgery for CHD are at high risk of developing thrombosis due to a hypercoagulable state often related to cardiopulmonary bypass and blood product transfusions[ 1 , 7 , 8 ].…”

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

“…Indeed, studies have demonstrated an increased incidence of thromboembolic complications in children receiving FFP. 22,23 This may be specifically an issue in children with single ventricle physiology, who are reported to be at higher risk of thromboembolic complications. 24,25 We did not observe any statistical difference in the incidence of thromboembolic events between the two study groups.…”

Catheter-related deep vein thrombosis in newborn infants

“…Pediatric patients who undergo heart surgery have a higher risk of developing thrombosis when compared to other hospitalized children. 22,23 There are several risk factors that have been associated with the development of thrombosis among these patients: young age (surgery in the neonatal period, 22,25 infants younger than 1 year), 26 oxygen saturation < 85 %, 22,25 use of deep hypothermic circulatory arrest, 22 transfusion of blood products during surgery 27,28 or after cardiopulmonary bypass, 25 postoperative use of extracorporeal support, 22 CVC use 26 (indwelling time, 22,24 presence of more than 1 catheter), 24 among others.…”