Coagulation considerations for infants and children undergoing cardiopulmonary bypass

Abstract

Cardiac surgery involving cardiopulmonary bypass imposes a significant pathophysiologic burden on patients. Pediatric patients are especially predisposed to the adverse effects of surgery and bypass on the coagulation system, with resultant bleeding, transfusion, and poor outcomes. These risks accrue to pediatric patients in inverse proportion to their weight and are attributable to hematologic immaturity, coagulation defects associated with congenital heart disease, bypass equipment, and the nature of congenital heart surgery. Standard anticoagulation does not completely inhibit thrombin generation, and continuous consumption of coagulation factor continues throughout bypass. Conventional measurements of anticoagulation during bypass poorly reflect this incomplete anticoagulation, and alternate methods may improve anticoagulant therapy. Emerging therapies for blocking the effects of bypass on the coagulation system hold promise for decreasing bleeding and related complications, and improving outcomes in congenital heart surgery.

Therapeutic Hypothermia Following Emergent Coronary Artery Bypass Grafting After Failed Percutaneous Coronary Intervention in a Comatose Post-Cardiac Arrest Patient

“…In our case, TH was maintained at a target of 34℃, but coagulation parameters, such as PT, aPTT, and INR, were prolonged, indicating coagulation abnormalities. However, these abnormalities might be influenced by a high dose of heparin and CPB pump application (17). …”

Anesthesia for Cardiac Surgery in Neonates

“…Risk factors include low birth weight, use of profound hypothermia, increased preoperative hematocrit, cyanosis, and complex surgery [ 214 ]. The increased risk of bleeding in the neonate is due to immaturity of the coagulation system, characterized by reduced plasma concentrations of both procoagulant and anticoagulant proteins (30-70 % of adult values) [ 215 ].…”

In-line filtration decreases systemic inflammatory response syndrome, renal and hematologic dysfunction in pediatric cardiac intensive care patients

“…The control group suffered from a higher incidence of hematological dysfunction characterized by thrombocytopenia and coagulopathy. As patients with CHD per se and even more pronounced in cyanotic CHD show an altered hemostatic physiology with decreased concentrations of coagulation factors and abnormalities of platelets [14], an additional infusion of particles obstructing small capillaries may worsen the preexisting coagulopathy [34,35]. No cardiac right-to-left shunt provided, in patients without particle-retentive in-line filters, the lung capillaries are the first endogenous filters for intravenously infused particles [15,34,35].…”