Thrombin Generation and Antithrombin Activity in Infants Undergoing Cardiopulmonary Bypass-An Exploratory Study.
J Cardiothorac Vasc Anesth
; 34(8): 2083-2090, 2020 Aug.
Article
em En
| MEDLINE
| ID: mdl-31901467
ABSTRACT
OBJECTIVES:
Coagulopathic bleeding is a major complication of pediatric cardiac surgery. Investigating perioperative dynamics of thrombin generation and antithrombin (AT) activity might provide more insight into the underlying mechanisms of coagulopathy. This can help develop a targeted hemostatic approach in the future. The authors hypothesized that there is a decline in both thrombin generation and AT activity in infants undergoing cardiopulmonary bypass (CPB).DESIGN:
Prospective observational study.SETTING:
Single academic medical center.PARTICIPANTS:
Infants <10 kg of weight undergoing cardiac surgery with CPB.INTERVENTIONS:
Blood specimen collection and testing. MEASUREMENTS ANDRESULTS:
The authors performed assays of thrombin generation and AT activity on the samples of platelet-poor plasma of 25 infants, repeating them at 3 points before CPB and heparinization, after separation from CPB and protamine administration, and after chest closure. The authors observed a statistically significant decline in thrombin generation shortly after separation from CPB compared with baseline. The geometric mean for lag time was prolonged (4.0 v 5.5 minutes, pâ¯=â¯0.013), and peak thrombin and the net amount of generated thrombin declined almost 3-fold (80.7 v 25.1 nmol, p < 0.001; 1264 v 476 nmol, p < 0.001, respectively). This was accompanied by a decline in AT activity (59.8 v 50.1, pâ¯=â¯0.001). After platelet and cryoprecipitate transfusion, at the case conclusion AT activity had recovered marginally (59.8 v 55.4, pâ¯=â¯0.042), but thrombin generation remained reduced.CONCLUSIONS:
In pediatric patients <10 kg undergoing cardiac surgery with CPB, thrombin generation and AT activity decline and do not recover completely after transfusion of platelets and cryoprecipitate.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Trombina
/
Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Observational_studies
Limite:
Humans
/
Infant
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article