title: Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology.
abstract: OBJECTIVE
  To determine the incidence and clinical and biomarker predictors of perioperative thrombosis in children with single ventricle physiology undergoing staged palliation.
  
  
  METHODS
  Nineteen patients were enrolled and 16 completed the study. Serial ultrasounds of the central venous system were performed to evaluate for thrombus. Plasma antithrombin III, thrombin-antithrombin complex, protein C, protein S, tissue factor pathway inhibitor, plasminogen activator inhibitor-1, tissue plasminogen activator antigen, D-dimer, soluble CD40 ligand, and urinary thromboxane were measured serially before and after surgery. Cardiopulmonary bypass time, aortic cross clamp time, blood product administration, inotrope score, chest tube output, cardiac function by echocardiography, intensive care unit and hospital lengths of stay, and central venous catheter days were recorded.
  
  
  RESULTS
  The incidence of perioperative thrombus was 31%. Patients who developed a thrombus had poorer preoperative ventricular function (p = 0.03) and longer cardiopulmonary bypass times (p = 0.03) than those who did not develop a thrombus. Preoperative plasma antithrombin III was lower (p = 0.01) and tissue plasminogen activator antigen concentrations were higher (p = 0.02) in patients with a thrombus compared with patients without a thrombus. When measured over time, antithrombin III remained lower (p = 0.002) and tissue plasminogen activator antigen higher (p = 0.005) in those who developed a thrombus compared with those who did not. There were no other statistically significant differences in biomarkers of coagulation between patients with and without thrombosis.
  
  
  CONCLUSIONS
  One-third of patients undergoing palliative surgery for single ventricle physiology develop thrombosis. Decreased ventricular function, low antithrombin III, and increased tissue plasminogen activator may predict those most suitable for randomized clinical trials of anticoagulation.
authors: Department of Pediatrics, Division of Critical Care, University of Kentucky School of Medicine, Lexington, KY, USA. drtodd0@uky.edu
authors: Deanna R
authors: DR
authors: Todd Tzanetos
authors: Chang
authors: C
authors: Yu
authors: Marta
authors: M
authors: Hernanz-Schulman
authors: Frederick E
authors: FE
authors: Barr
authors: Nancy J
authors: NJ
authors: Brown
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D002490:Central Nervous System / Q000000981:diagnostic imaging; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D010166:Palliative Care; D019990:Perioperative Care; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013714:Tennessee / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology*; D014463:Ultrasonography
chemical_list: D015415:Biomarkers