Functional Maturity of the Coagulation System in Children

Miller, Bruce E.; Bailey, James M.; Mancuso, Thomas J.; Weinstein, Michael; Holbrook, G. Wayne; Silvey, Eva M.; Tosone, Steven R.; Levy, Jerrold H.

doi:10.1097/00000539-199704000-00008

Cited by 41 publications

(64 citation statements)

References 18 publications

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“…In the literature, it is documented that younger children are at decreased risk for thrombotic events, largely due to differences in serum levels of coag- ulation factors compared with adults. 1,13,18,22,27 In addition, older children are more likely to have comorbid conditions such as obesity and use oral contraceptives, which may also increase the risk of VTE in that age group. 27 In keeping with our age-related findings, Vavilala et al found that children older than 10 years of age had a 5-fold risk of VTE compared with children younger than 5 years.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in the setting of pediatric traumatic brain injury

Harris¹,

Lam²

2014

PED

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Object The risk of venous thromboembolism (VTE) in children with traumatic brain injury (TBI) has not been well characterized given its rarity in the pediatric population. Investigation of risk factors for VTE in this group requires the use of a large sample size. Using nationally representative hospital discharge data for 2009, the authors of this study characterize the incidence and risk factors for VTE in children hospitalized for TBI. Methods The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to examine VTE in TBI-associated hospitalizations for patients 20 years of age or younger during the year 2009. Results There were 58,529 children with TBI-related admissions, including 267 with VTE diagnoses. Venous thromboembolisms occurred in 4.6 per 1000 TBI-associated hospitalizations compared with 1.2 per 1000 pediatric hospitalizations overall. By adjusted logistic regression, patients significantly more likely to be diagnosed with VTE had the following: older age of 15–20 years (adjusted odds ratio [aOR] 3.7, 95% CI 1.8–8.0), venous catheterization (aOR 3.0, 95% CI 2.0–4.6), mechanical ventilation (aOR 1.9, 95% CI 1.2–2.9), tracheostomy (aOR 2.3, 95% CI 1.3–4.0), nonaccidental trauma (aOR 2.8, 95% CI 1.1–6.9), increased length of stay (aOR 1.02, 95% CI 1.01–1.03), orthopedic surgery (aOR 2.4, 95% CI 1.8–3.4), and cranial surgery (aOR 1.8, 95% CI 1.1–2.8). Conclusions Using the Kids' Inpatient Database, the authors found that risk factors for VTE in the setting of TBI in the pediatric population include older age, venous catheterization, nonaccidental trauma, increased length of hospital stay, orthopedic surgery, and cranial surgery.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in the setting of pediatric traumatic brain injury

Harris¹,

Lam²

2014

PED

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“…3 Clinical implications of the prolonged aPTT observed up to three months of age and of decreased platelet function throughout childhood are unclear, since measurement of whole blood coagulation shows a relative hypercoagulable state as demonstrated by a decreased reaction-time with the thromboelastograph in infants (under one year of age). 4 Moreover, the bleeding time is shorter in newborns. This might be due to higher levels of von Willebrand factor and increased hematocrit.…”

Section: Developmental Aspects Of Hemostasismentioning

confidence: 99%

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Guay

Moerloose

Lasne

2006

Can J Anesth/J Can Anesth

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Purpose: To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. Methods:The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery. Main findings:For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while antikallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants. Conclusion:Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery. I N normal children perioperative blood loss leading to administration of allogenic transfusion may be encountered if: the surgical site does not allow easy access to surgical hemostasis, the surgery is performed on highly vascularized tissues that are not easily sutured or cauterized (for example bone elements such as in spinal fusion or correction of craniosynostosis) or the surgery itself induces various disturbances of hemostasis (dilution of factors and induction of fibrinolysis as in cardiac surgery with the use of extracorporeal bypass). The pathology justifying the surgical procedure may also induce various coagulation and/or hemostatic abnormalities. Children suffering from congenital cardiac or liver dis- ease may have thrombocytopenia, abnormal platelet function (congenital heart disease) and/or inadequate amounts of various coagulation factors. Objectif1 Perioperative management of children with congenital coagulation and hemostatic diseases will not be discussed in this review. Developmental aspects of hemostasisAn excellent summary of the developmental physiology of coagulation, based mainly on the extensive work of Maureen Andrew, may be found in a recent review by Kuhle et al. and is summarized in Table I.2 Since maternal coagulation factors do not cross the placental barrier, blood levels measured at birth are the result of fetal synthesis that starts around the fifth week of gestation. Fetal blood becomes clottable around 11 weeks of gestation. Except fetal fibrinogen which has an increased content of sialic acid, all coagulation and inhibitor factors are qualitatively normal at birth, and differ from...

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“…There are several reasons why TEG ® has not been adopted in mainstream clinical practice (14)(15)(16). One reason is its excessive dependence on manual procedures compared to other standard coagulation testing devices, a source of criticism by laboratory societies (8,(17)(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%