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Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease

Murphy, Lee D., DO, MS1; Benneyworth, Brian D., MD, MS1; Moser, Elizabeth A. S., MS2; Hege, Kerry M., MD, MS3; Valentine, Kevin M., MD1; Mastropietro, Christopher W., MD1

doi: 10.1097/PCC.0000000000001743
Cardiac Intensive Care

Objectives: Thrombosis is a cause of morbidity in 4–15% of children who undergo pediatric cardiac surgery. Data on how to prevent this complication are sorely needed. We aimed to identify risk factors for thrombosis following pediatric cardiac surgery and determine if use of low molecular weight heparin prophylaxis is associated with a reduction in thrombosis risk.

Design: Retrospective cohort study.

Setting: Tertiary pediatric cardiovascular ICU.

Patients: Patients who underwent cardiac surgery between June 2014 and December 2015.

Interventions: None.

Measurements and Main Results: Data from patients with venous or arterial thrombosis confirmed by radiologic studies were matched two-to-one to controls based on age, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, and gender. Thrombosis was detected in 33 patients (6.2%): 25 patients (76%) had venous thromboses, five patients (15%) had arterial thromboses, and three patients (9%) had both. Median time to thrombosis detection was 13 days (25–75%; 7–31 d). On multivariate analysis, which included adjustment for postoperative disease severity, fresh frozen plasma exposure was independently associated with thrombosis (odds ratio, 3.7; 95% CI, 1.4–9.4). Twenty-eight patients (85%) had central venous catheter-related thromboses. Low molecular weight heparin prophylaxis use in this subset of patients was not statistically different from controls (50% vs 45%, respectively; p = 0.47). On multivariable analysis, fresh frozen plasma exposure was also independently associated with central venous catheter-related thrombosis (odds ratio, 3.6; 95% CI, 1.2–10.6).

Conclusions: The occurrence of thrombosis after pediatric cardiac surgery at our institution was 6.2%, similar to what has been reported in other studies, despite frequent use of low molecular weight heparin. Further study is needed to determine the role of low molecular weight heparin for thromboprophylaxis and the relationship between fresh frozen plasma and thrombosis risk in children who undergo cardiac surgery.

1Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

2Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN.

3Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

This work was completed at Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

A percentage of Ms. Moser’s salary as a biostatistician at Indiana University is supported by Riley Children’s Hospital’s Critical Care Department, in exchange for her statistical support. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: cmastrop@iupui.edu

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies