Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease
| Autor: | Christopher W. Mastropietro, Brian D. Benneyworth, Elizabeth A. S. Moser, Kevin Valentine, Lee D Murphy, Kerry Hege |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Heart Defects
Congenital Male medicine.medical_specialty Heart disease medicine.drug_class Low molecular weight heparin 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Intensive Care Units Pediatric 03 medical and health sciences 0302 clinical medicine Postoperative Complications Fibrinolytic Agents Risk Factors medicine Central Venous Catheters Humans 030212 general & internal medicine Cardiac Surgical Procedures Retrospective Studies business.industry Case-control study Infant Newborn Infant Retrospective cohort study Thrombosis Odds ratio Heparin Low-Molecular-Weight medicine.disease Surgery Cardiac surgery Case-Control Studies Pediatrics Perinatology and Child Health Female Fresh frozen plasma business |
| Zdroj: | Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 19(12) |
| ISSN: | 1529-7535 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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