title: Association Between Hematologic and Inflammatory Markers and 31 Thrombotic and Hemorrhagic Events in Berlin Heart Excor Patients.
abstract: Bleeding and thrombotic events remain a significant cause of morbidity in pediatric patients supported with ventricular assist devices (VADs). The objective of this study is to identify the association between markers of anticoagulation and bleeding and thrombosis events during Berlin Heart ExCor support. A retrospective, single-center analysis of 9 patients supported with the Berlin Heart ExCor was performed. Inflammatory and anticoagulation parameters including C-reactive protein, fibrinogen, partial thromboplastin time (PTT), and platelet count were measured at 48 and 24 h before and after bleeding or thrombosis events. Patients served as their own controls, and the same parameters were measured during a control period where subjects did not experience either event. All patients received the anticoagulation regimen proposed by Berlin Heart. A total of 31 bleeding or thrombotic events were identified and matched to 18 control events. Patient with predominantly thrombotic events tended to weigh less than those with bleeding events (Δ7.7 kg, p < 0.001). PTT levels were higher before and after bleeding (Δ17.36, p = 0.002) and thrombosis (Δ8.75, p < 0.001) events relative to control. Heparin dose decreased after a thrombosis event (Δ-5.67, p = 0.097), and this decrease was significantly different from control (p = 0.032). Non-collinearity between heparin dose and PTT should prompt further inflammatory and hematological investigation. In addition, heavier patients were more prone to bleeding complications. The role of inflammation in the development of thrombus or hemorrhages in the pediatric VAD population needs to be studied further.
authors.affiliation: David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Iyengar
authors.affiliation: David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hung
authors.affiliation: David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Kian
authors.initials: K
authors.lastname: Asanad
authors.affiliation: Department of Cardiothoracic Surgery, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Oh Jin
authors.initials: OJ
authors.lastname: Kwon
authors.affiliation: Department of Medicine Statistics Core, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Jackson
authors.affiliation: Department of Cardiothoracic Surgery, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Reemtsen
authors.affiliation: Department of Pediatrics, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA.
authors.forename: Myke D
authors.initials: MD
authors.lastname: Federman
authors.affiliation: Department of Cardiothoracic Surgery, Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA. rbiniwale@mednet.ucla.edu.|, 10833 Le Conte Avenue, Suite 62-266 CHS, Los Angeles, CA, 90095, USA. rbiniwale@mednet.ucla.edu.
authors.forename: Reshma M
authors.initials: RM
authors.lastname: Biniwale
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D006333:Heart Failure / Q000097:blood / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D015415:Biomarkers
keywords: Anticoagulation; Berlin heart; Predictors; Steroids; Thromboembolism