Dissimilarity in coagulation system in adults after Fontan surgery based on thrombin generations.

Autor:	Skorek P; Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland., Skubera M; Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland., Natorska J; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.; Center for Research and Innovative Technology, John Paul II Hospital, Kraków, Poland., Ząbczyk M; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.; Center for Research and Innovative Technology, John Paul II Hospital, Kraków, Poland., Trojnarska O; 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland., Pająk J; Institute of Medical Sciences, Department of Surgery, Medical College of Rzeszow University, Rzeszow, Poland., Mazurek-Kula A; Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Łódź, Poland., Bartczak-Rutkowska A; 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland., Podolec P; Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland., Tomkiewicz-Pająk L; Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2022 Dec 02; Vol. 63 (1).
DOI:	10.1093/ejcts/ezac550
Abstrakt:	Objectives: The Fontan procedure is the treatment of choice in congenital cardiac malformations defined as the single ventricle. Fontan patients are at high risk of thromboembolism, but the exact mechanism of this is poorly understood. The aim of this study was to evaluate an involvement of thrombin generations and microparticles (MPs) in prothrombotic state in adults with Fontan circulation. Methods: This study included hospitalized patients after Fontan procedure and healthy volunteers. We assessed laboratory tests including thrombin generation by calibrated automated thrombography in three variants [platelet-poor plasma (impact of coagulation factors), platelet-rich plasma (PRP) (influence of platelets) and related with MPs]. The technique allows for a comprehensive evaluation of the coagulation system. Results: The study groups consisted of 81 adult Fontan patients [41 females (50.6%); median age 22 interquartile range [20-27] years] and 54 control subjects. In patients with Fontan circulation, higher values of endogenous thrombin potential and peak values were observed for both platelet-poor plasma (+17% and +33%) and MPs (+29% and 41%) compared to controls (all P < 0.05). Moreover, in the Fontan group, we found a 64.9% shorter lag time and a 70.4% time to peak for MP variant (both P < 0.001). Contrarily, analysis in the PRP showed 17.1% of reduced endogenous thrombin potential in Fontan. Furthermore, there were no differences in thrombin synthesis in PRP in Fontan patients receiving aspirin or those with thrombocytopaenia (all P > 0.05). Conclusions: This study for the first time showed that thrombin generation associated with MPs may be an important contributor to the prothrombotic state in the Fontan population. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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