Calibrated automated thrombogram values in infants with cardiac surgery before and after cardiopulmonary bypass

Alessandra Rizza, Giovina Di Felice, Rosa Luciano, Ottavia Porzio, Ombretta Panizzon, Maurizio Muraca, Paola Cogo

Research output: Contribution to journalArticle

Abstract

Introduction Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB. Materials and methods Prospective observational study performed in children aged < 24 months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12 h (T2). Perioperative bleeding management was performed according to the institutional guidelines. Results Forty-nine children aged < 24 months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged < 6 months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions. Conclusions Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged < 6 months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12 h after surgery despite transfusions of blood products.

Original languageEnglish
Pages (from-to)91-96
Number of pages6
JournalThrombosis Research
Volume160
DOIs
Publication statusPublished - Dec 1 2017

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Thrombelastography
Cardiopulmonary Bypass
Thoracic Surgery
Thrombin
Phospholipids
Platelet Count
Blood Transfusion
Fibrinogen
Hemorrhage
Partial Thromboplastin Time
Prothrombin Time
Anticoagulants
Observational Studies
Heart Diseases
Anesthesia
Prospective Studies
Guidelines

Keywords

  • Blood transfusion
  • Coagulation
  • Congenital heart disease
  • Thrombin generation
  • Thromboelastography

ASJC Scopus subject areas

  • Hematology

Cite this

Calibrated automated thrombogram values in infants with cardiac surgery before and after cardiopulmonary bypass. / Rizza, Alessandra; Di Felice, Giovina; Luciano, Rosa; Porzio, Ottavia; Panizzon, Ombretta; Muraca, Maurizio; Cogo, Paola.

In: Thrombosis Research, Vol. 160, 01.12.2017, p. 91-96.

Research output: Contribution to journalArticle

Rizza, Alessandra ; Di Felice, Giovina ; Luciano, Rosa ; Porzio, Ottavia ; Panizzon, Ombretta ; Muraca, Maurizio ; Cogo, Paola. / Calibrated automated thrombogram values in infants with cardiac surgery before and after cardiopulmonary bypass. In: Thrombosis Research. 2017 ; Vol. 160. pp. 91-96.
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abstract = "Introduction Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB. Materials and methods Prospective observational study performed in children aged < 24 months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12 h (T2). Perioperative bleeding management was performed according to the institutional guidelines. Results Forty-nine children aged < 24 months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged < 6 months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions. Conclusions Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged < 6 months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12 h after surgery despite transfusions of blood products.",
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N2 - Introduction Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB. Materials and methods Prospective observational study performed in children aged < 24 months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12 h (T2). Perioperative bleeding management was performed according to the institutional guidelines. Results Forty-nine children aged < 24 months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged < 6 months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions. Conclusions Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged < 6 months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12 h after surgery despite transfusions of blood products.

AB - Introduction Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB. Materials and methods Prospective observational study performed in children aged < 24 months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12 h (T2). Perioperative bleeding management was performed according to the institutional guidelines. Results Forty-nine children aged < 24 months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged < 6 months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions. Conclusions Thrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged < 6 months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12 h after surgery despite transfusions of blood products.

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