title: Hypercoagulability panel testing predicts thrombosis in neonates undergoing cardiac surgery.
abstract: Thrombosis contributes to morbidity and mortality in neonates following cardiac surgery. Alterations in hemostatic factors following cardiac surgery have been described, but there is no data correlating these changes with risk of thrombosis in neonates. The aim of this study is to predict thrombosis in neonates undergoing cardiac surgery by assessment of a panel of hypercoagulability markers. Neonates undergoing cardiac surgery were enrolled preoperatively and prospectively followed. Preoperative hypercoagulability panel testing included thrombin generation assay (TGA), immunoassays for antithrombin III, protein C, protein S, factor VIII, thrombin-activatable fibrinolytic inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1), and cardiolipin antibody. Postoperative thrombosis was defined by clinical events (shunt thrombosis, limb ischemia, and stroke) or imaging (intravascular or intracardiac thrombus). Risk factors for thrombosis were assessed. One hundred neonates were enrolled in the study over a two-year period. The incidence of postoperative in-hospital thrombosis was 20%. The only significant clinical risk factor associated with thrombosis was the single ventricle physiology. Hypercoagulability factors associated with increased risk of thrombosis by univariate analysis were elevated PAI-1, TAFI, and TGA, and presence of anticardiolipin antibodies. Multivariable logistic regression analysis demonstrated that elevated PAI-1 (P = 0.015), TAFI (P = 0.028), and TGA (P = 0.007) were independent predictors of thrombosis. Hypercoagulability panel testing may help identify neonates at high risk for thrombosis following cardiac surgery. Future studies are warranted to determine if high risk patients benefit from targeted anticoagulation therapies.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sirisha
authors.initials: S
authors.lastname: Emani
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Cameron
authors.initials: C
authors.lastname: Trenor
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
mesh_terms: D000293:Adolescent; D017153:Antibodies, Anticardiolipin / Q000097:blood; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000378:metabolism; D001780:Blood Coagulation Tests / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D015849:Plasminogen Inactivators / Q000378:metabolism; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D013917:Thrombin / Q000096:biosynthesis; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D017153:Antibodies, Anticardiolipin; D001779:Blood Coagulation Factors; D015849:Plasminogen Inactivators; D013917:Thrombin