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The Coagulative Profile of Cyanotic Children Undergoing Cardiac Surgery: The Role of Whole Blood Preoperative Thromboelastometry on Postoperative Transfusion Requirement
Author(s) -
Vida Vladimiro L.,
Spiezia Luca,
Bortolussi Giacomo,
Marchetti Marta E.,
Campello Elena,
Pittarello Demetrio,
Gregori Dario,
Stellin Giovanni,
Simioni Paolo
Publication year - 2016
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12629
Subject(s) - medicine , thromboelastometry , cardiopulmonary bypass , anesthesia , hematocrit , interquartile range , cryoprecipitate , surgery , prothrombin time , partial thromboplastin time , platelet , whole blood , cardiology
The objective of this study is to evaluate the preoperative coagulation pattern and its association to postoperative blood products transfusion in children with congenital heart disease ( CH D), focusing on cyanotic patients (oxygen saturation, SATO 2 < 85%). From J anuary to A ugust 2014, preoperative standard coagulation tests and rotational thromboelastometry assays were performed on 81 pediatric patients (<16 years old) who underwent surgery for CHD with the aid of cardiopulmonary bypass. Sixty patients (74%) were acyanotic and 21 (26%) cyanotic. Mean age at time of surgery was 7.9 months (interquartile range 2.9–43.6 months). Cyanotic patients had a significantly higher hematocrit ( P < 0.001), a reduced prothrombin activity ( PT ) ( P = 0.01) level, and a lower platelet count ( P = 0.02) than acyanotic patients. An inverse linear association was found between patient's SATO 2 and clot formation time ( CFT ) ( INTEM , P = 0.001, and EXTEM , P < 0.0001). A direct linear association was found between patient's SATO 2 and maximum clot firmness ( MCF ) ( INTEM , P = 0.04, and EXTEM , P = 0.05). Preoperative cyanosis was also associated with a lower median MCF in FIBTEM ( P = 0.02). Cyanotic patients required more frequent postoperative transfusions of fibrinogen (7/21 patients, 33% vs. 4/60 patients, 6.7%, P = 0.01) and fresh frozen plasma (14/21, 67% vs. 25/60, 42%, P = 0.08). Patients with a lower presurgery PT and platelet count subsequently required more fibrinogen transfusion P = 0.02 and P = 0.003, respectively); the same goes for patients with a longer CFT ( INTEM , P = 0.01 and EXTEM , P = 0.03) and a reduced MCF ( INTEM , P = 0.02 and FIBTEM , P = 0.01) as well. Cyanotic patients showed significant preoperative coagulation anomalies and required a higher postoperative fibrinogen supplementation. The preoperative MCF FIBTEM has become an important factor in our postoperative thromboelastometry‐guided transfusion protocols.