Hypercoagulability markers predict thrombosis in single ventricle neonates undergoing cardiac surgery

Abstract

Background: Incidence of thrombosis in neonates undergoing cardiac surgery is as high as 20%, and single ventricle physiology (SVP) may present an even higher risk. We hypothesize that SVP is a risk factor for thrombosis in neonates undergoing cardiac surgery, and hypercoagulability biomarkers are predictive of postoperative thrombosis.

Methods: Records of 512 neonates undergoing cardiac surgery were retrospectively reviewed. Thrombosis was defined by clinical events (shunt thrombosis, limb ischemia, and stroke) or intravascular or cardiac thrombus by echocardiography. Clinical variables, including SVP and cardiopulmonary bypass (CPB), were analyzed using multivariable logistic regression. A hypercoagulability biomarker panel was obtained in a subset of patients with SVP and compared between neonates with and without thrombosis.

Results: Thrombosis was detected in 51 of 512 neonates undergoing cardiac surgery. Intensive care and hospital lengths of stay were longer in patients who experienced thrombosis compared with those who did not (14 ± 13 vs 6 ± 1 days, 23 ± 4 vs 13 ± 1 days, p < 0.001). The SVP and use of CPB were significant risk factors for thrombosis, and the rate of thrombosis in SVP patients was 16.2% (16 of 99) compared with 8.5% (35 of 413) in non-SVP patients (p = 0.038). Thrombin generation, plasminogen activator inhibitor, and thrombin activatable fibrinolysis inhibitor were significantly elevated in SVP patients with thrombosis compared to without thrombosis (p < 0.05).

Conclusions: Single ventricle physiology patients are at higher risk for thrombosis compared with other neonates after cardiac surgery. Hypercoagulable panel testing may help risk stratify patients and guide patient specific anticoagulation management in the postoperative period.

Keywords: 21; ATIII; CI; CPB; FVIII; ICU; LOS; PAI-1; PC; PPP; PS; RFU; ROC; SVP; TAFI; TGA; antithrombin III; cardiopulmonary bypass; confidence interval; factor VIII; intensive care unit; length of stay; plasminogen activator inhibitor; platelet poor plasma; protein C; protein S; receiver operating characteristic; relative fluorescence units; single ventricle physiology; thrombin activatable fibrinolytic inhibitor; thrombin generation assay.