title: Assessment of coagulation profile by thromboelastometry in adult patients with cyanotic congenital heart disease.
abstract: BACKGROUND
  Patients with cyanotic congenital heart disease (CCHD) have an increased risk of bleeding and thrombotic complications. Prolonged conventional coagulation screening parameters, such as activated partial thromboplastin time or prothrombin time, are reported in less than 20% of CCHD patients.
  
  
  METHODS
  The aim of this study was to determine the haemostatic abnormalities in 32 adult patients with CCHD by rotation thromboelastometry (ROTEM) with assessment of coagulation dynamic properties, as a guide for perioperative prophylaxis or haemostatic therapy. The control group consisted of 35 healthy subjects.
  
  
  RESULTS
  Our results suggest that CCHD patients, in comparison to healthy controls, had a tendency to hypocoagulate with delayed activation of haemostasis and clot formation, initiated by both intrinsic and extrinsic activators. The growth of the clot was slower and the clot firmness was decreased, which may additionally contribute to bleeding diathesis. Moreover, the clot lysis readings suggest higher clot stability in the CCHD group. All velocity parameters were markedly lower in the CCHD patients, indicating a decreased rate of clot formation. Although coagulation tests and platelet count were normal, the usefulness of rotation thromboelastometry in monitoring or guiding therapy in CCHD patients is demonstrated.
  
  
  CONCLUSIONS
  In conclusion, our results provide new insights into the data on hypocoagulation with impaired clot lysis in adult CCHD patients as determined by ROTEM. Our findings may assist in determining the optimal management of patients with CCHD undergoing surgery.
authors.affiliation: Department of Haematology, Poznan University of Medical Sciences, Poznań, Poland. Electronic address: rupa.matysek@gmail.com.
authors.forename: Joanna
authors.initials: J
authors.lastname: Rupa-Matysek
authors.affiliation: 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Trojnarska
authors.affiliation: Department of Haematology, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Lidia
authors.initials: L
authors.lastname: Gil
authors.affiliation: Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Ludwina
authors.initials: L
authors.lastname: Szczepaniak-Chicheł
authors.affiliation: Department of Haematology, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Wojtasińska
authors.affiliation: Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tykarski
authors.affiliation: 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.affiliation: Department of Haematology, Poznan University of Medical Sciences, Poznań, Poland.
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Komarnicki
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests / Q000379:methods; D003490:Cyanosis / Q000097:blood / Q000150:complications / Q000473:pathology*; D005260:Female; D005340:Fibrinogen / Q000502:physiology; D005342:Fibrinolysis / Q000502:physiology; D006331:Heart Diseases / Q000097:blood / Q000150:complications / Q000151:congenital* / Q000473:pathology*; D006470:Hemorrhage / Q000097:blood / Q000150:complications / Q000473:pathology; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000379:methods; D019990:Perioperative Care; D011517:Prothrombin Time; D013916:Thrombelastography / Q000379:methods*; D013927:Thrombosis / Q000097:blood / Q000150:complications / Q000473:pathology; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D005340:Fibrinogen
keywords: Coagulation profile; Cyanotic congenital heart disease; Surgery; Thromboelastometry