Management and Outcomes of Patients with Occlusive Thrombosis after Pediatric Cardiac Surgery

详细信息    查看全文

• 作者：Cedric Manlhiot ; PhD¹ ; Leonardo R. Brandã ; o ; MD² ; Steven M. Schwartz ; MD¹ ; V. Ben Sivarajan ; MD¹ ; Suzan Williams ; MD² ; Tanveer H. Collins ; MD¹ ; Brian W. McCrindle ; MD ; MPH¹ ; ^{brian.mccrindle@sickkids.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HR ; Hazard ratio
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：169
• 期：Complete
• 页码：146-153
• 全文大小：720 K

文摘

To evaluate management and outcomes of thrombosis after pediatric cardiac surgery and stratify thrombi according to risk of short- and long-term complications to better guide therapeutic choices.

Study design

Retrospective review was performed of 513 thrombi (400 occlusive) diagnosed after 213 pediatric cardiac operations. Long-term outcomes over time were assessed with the use of parametric hazard regression models.

Results

Serious complications and/or high-intensity treatment occurred with 17%-24% of thrombi depending on location, most commonly in thrombi affecting the cardiac and cerebral circulation. Bleeding complications affected 13% of patients; associated factors included thrombolytics (OR 8.7, P < .001), greater daily dose of unfractionated heparin (OR 1.25 per 5 U/kg/day, P = .03), and extracorporeal support (OR 4.5, P = .007). Radiologic thrombus persistence was identified in 30% ± 3% at 12 months; associated factors included extracorporeal support (hazard ratio [HR] 1.9, P = .003), venous (HR 1.7, P = .003), and occlusive thrombi at presentation (HR 1.8, P = .001); greater oxygen saturation before surgery (HR 1.13/10%, P = .05) and thrombi in femoral veins (HR 1.9, P = .001) were associated with increased hazard of resolution. Freedom from postthrombotic syndrome was 83% ± 4% at 6 years, greater number of persistent vessel segment occlusions (HR 1.8/vessel, P = .001) and greater fibrinogen at diagnosis (HR 1.1 per g/L, P = .02) were associated with increased hazard.

Conclusions

Thrombosis outcomes after pediatric cardiac surgery remain suboptimal. Given that more intensive treatment would likely increase the risk of bleeding, the focus should be on both thrombosis-prevention strategies, as well as in tailoring therapy according to a thrombosis outcome risk stratification approach.