Tactics of managing children-patients with post-coagulopathy cardiac surgery interventions
DOI:
https://doi.org/10.57125/FEM.2022.12.30.04Keywords:
cardiac surgery, pediatric, coagulopathy, post-operative, managementAbstract
Background: Children with congenital heart disease undergoing complicated pediatric cardiac surgery with cardiopulmonary bypass (CPB) experience considerable post-operative mortality and morbidity due to post-operative bleeding. An impairment in the blood clotting system primarily contributes to excessive bleeding in children following heart surgery.
Aim: to assess the different methods for the treatment of pediatric patients with post-coagulopathy cardiac surgery.
Methods: Pubmed, Web of Science, Scopus, Embase, SpringerLink, and the Cochrane Library in order to find various articles concerning this topic were searched. The search strategy; (cardiac surgery) AND (pediatric) AND (coagulopathy) AND (post-operative) was used. The investigation ended in April 2022.
Scientific novelty: Post-coagulopathy cardiac surgery is a relatively new medical field that has seen tremendous advances in the past decade. It involves the use of specialised techniques to reduce the risk of bleeding during and after cardiac surgery. This includes the use of anticoagulants, thrombolytics, and other medications to reduce clotting and improve outcomes. In addition, newer technologies such as robotic-assisted surgery have been developed to improve precision and accuracy during cardiac procedures. Therefore, this review aims to address the tactics of managing children-patients with post-coagulopathy cardiac surgery
Conclusion: The management of children-patients with post-coagulopathy cardiac surgery is a particularly challenging area due to their unique physiology and anatomy. As such, there is a need for novel approaches to ensure optimal outcomes for these patients. For example, research has shown that using anticoagulants in combination with thrombolytics can reduce the risk of bleeding complications following cardiac surgery in pediatric patients.
References
Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers [Internet]. 2021;7(1):30. Available from: http://dx.doi.org/10.1038/s41572-021-00264-3
Uaprasert N, Moonla C, Sosothikul D, Rojnuckarin P, Chiasakul T. Systemic coagulopathy in hospitalized patients with Coronavirus Disease 2019: A systematic review and meta-analysis. Clin Appl Thromb Hemost [Internet]. 2021; 27:1076029620987629. Available from: http://dx.doi.org/10.1177/1076029620987629
Pereira KMFSM, de Assis CS, Cintra HNWL, Ferretti-Rebustini REL, Püschel VAA, Santana-Santos E, et al. Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study. J Clin Nurs [Internet]. 2019;28(5–6):850–61. Available from: http://dx.doi.org/10.1111/jocn.14670
Baeza-Herrera LA, Rojas-Velasco G, Márquez-Murillo MF, Portillo-Romero ADR, Medina-Paz L, Álvarez-Álvarez R, et al. Atrial fibrillation in cardiac surgery. Arch Cardiol Mex [Internet]. 2019;89(4):348–59. Available from: http://dx.doi.org/10.24875/ACM.19000134
Okoye HC, Korubo KI, Nwogoh B, Efobi CC, Ugwu NI, Madu AJ. Challenges in the management of bleeding disorders in Nigeria. Niger J Clin Pract [Internet]. 2018;21(4):468–72. Available from: http://dx.doi.org/10.4103/njcp.njcp_319_17
Saito H, Kojima T. Unrecognized blood clotting factors. Int J Hematol [Internet]. 2021;113(6):785–8. Available from: http://dx.doi.org/10.1007/s12185-021-03133-7
Burggraf M, Polan C, Husen M, Mester B, Wegner A, Spodeck D, et al. Trauma induced clotting factor depletion in severely injured children: a single center observational study. World J Emerg Surg [Internet]. 2020;15(1):31. Available from: http://dx.doi.org/10.1186/s13017-020-00311-6
Reyes Gil M. Overview of the coagulation system. In: Transfusion Medicine and Hemostasis. Elsevier; [Internet]. 2019. p. 559–64. Available from: https://doi.org/10.1016/B978-0-12-813726-0.00091-X
Nasimuzzaman M, Malik P. Role of the coagulation system in the pathogenesis of sickle cell disease. Blood Adv [Internet]. 2019;3(20):3170–80. Available from: http://dx.doi.org/10.1182/bloodadvances.2019000193
Fedorov VE, Kharitonov BS, Aslanov AD, Logvina OE, Narizhnaya MS. Changes in the blood coagulation system that determine postoperative complications in patients with non-tumor mechanical jaundice. Grekov’s Bulletin of Surgery. 2021 Aug;180(2):12–20.
Liang Y, Xie S-B, Wu C-H, Hu Y, Zhang Q, Li S, et al. Coagulation cascade and complement system in systemic lupus erythematosus. Oncotarget [Internet]. 2018;9(19):14862–81. Available from: http://dx.doi.org/10.18632/oncotarget.23206
Zhang Y, Chen X, Cao Y, Yang Z. C8B in complement and coagulation cascades signaling pathway is a predictor for survival in HBV-related hepatocellular carcinoma patients. Cancer Manag Res [Internet]. 2021;13:3503–15. Available from: http://dx.doi.org/10.2147/CMAR.S302917
Satyam A, Graef ER, Lapchak PH, Tsokos MG, Dalle Lucca JJ, Tsokos GC. Complement and coagulation cascades in trauma. Acute Med Surg [Internet]. 2019;6(4):329–35. Available from: http://dx.doi.org/10.1002/ams2.426
Pant A, Kopec AK, Luyendyk JP. Role of the blood coagulation cascade in hepatic fibrosis. Am J Physiol Gastrointest Liver Physiol [Internet]. 2018;315(2):G171–6. Available from: http://dx.doi.org/10.1152/ajpgi.00402.2017
Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth [Internet]. 2014;58(5):515–23. Available from: http://dx.doi.org/10.4103/0019-5049.144643
Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood [Internet]. 2016;128(8):1043–9. Available from: http://dx.doi.org/10.1182/blood-2016-01-636423
Ho VK, Wong J, Martinez A, Winearls J. Trauma-induced coagulopathy: Mechanisms and clinical management. Ann Acad Med Singapore [Internet]. 2022;51(1):40–8. Available from: http://dx.doi.org/10.47102/annals-acadmedsg.2020381
Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: The past, present, and future. J Thromb Haemost [Internet]. 2019;17(6):852–62. Available from: http://dx.doi.org/10.1111/jth.14450
Drucker NA, Wang SK, Newton C. Pediatric trauma-related coagulopathy: Balanced resuscitation, goal-directed therapy and viscoelastic assays. Semin Pediatr Surg [Internet]. 2019;28(1):61–6. Available from: http://dx.doi.org/10.1053/j.sempedsurg.2019.01.011
Ise H, Kitahara H, Oyama K, Takahashi K, Kanda H, Fujii S, et al. Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis. Gen Thorac Cardiovasc Surg [Internet]. 2020;68(8):754–61. Available from: http://dx.doi.org/10.1007/s11748-020-01399-y
Paparella D, Whitlock R. Safety of salvaged blood and risk of coagulopathy in cardiac surgery. Semin Thromb Hemost [Internet]. 2016;42(2):166–71. Available from: http://dx.doi.org/10.1055/s-0035-1569067
Bartoszko J, Martinez-Perez S, Callum J, Karkouti K, FIBRES Study Investigators. Impact of cardiopulmonary bypass duration on efficacy of fibrinogen replacement with cryoprecipitate compared with fibrinogen concentrate: a post hoc analysis of the Fibrinogen Replenishment in Surgery (FIBRES) randomised controlled trial. Br J Anaesth [Internet]. 2022;129(3):294–307. Available from: http://dx.doi.org/10.1016/j.bja.2022.05.012
Koster A, Hulde N, von Dossow V, Erdoes G. Perioperative management of severe acquired coagulopathy in patients with left ventricular assist device—a literature review and expert recommendations. Curr Anesthesiol Rep [Internet]. 2021;11(1):76–83. Available from: http://dx.doi.org/10.1007/s40140-021-00434-9
Tang M, Fenger-Eriksen C, Wierup P, Greisen J, Ingerslev J, Hjortdal V, et al. Rational and timely haemostatic interventions following cardiac surgery - coagulation factor concentrates or blood bank products. Thromb Res [Internet]. 2017;154:73–9. Available from: http://dx.doi.org/10.1016/j.thromres.2017.04.004
Boxma RPJ, Garnier RP, Bulte CSE, Meesters MI. The effect of non-point-of-care haemostasis management protocol implementation in cardiac surgery: A systematic review. Transfus Med [Internet]. 2021;31(5):328–38. Available from: http://dx.doi.org/10.1111/tme.12790
de Marco F, Romano A, Casenghi M, Berti S. Patient selection, procedural planning and interventional guidance for non-valvular structural intervention. Minerva cardiology and angiology [Internet]. 2021 Dec 1 [cited 2023 Apr 10];69(6):720–34. Available from: https://pubmed.ncbi.nlm.nih.gov/34870383/
Egidy Assenza G, Krieger EV, Baumgartner H, Cupido B, Dimopoulos K, Louis C, et al. AHA/ACC vs ESC guidelines for management of adults with congenital heart disease: JACC guideline comparison. J Am Coll Cardiol [Internet]. 2021;78(19):1904–18. Available from: http://dx.doi.org/10.1016/j.jacc.2021.09.010
Katewa A. Pediatric cardiac surgery: a status report on availability, access, and funding across 193 countries. Indian Journal of Thoracic and Cardiovascular Surgery [Internet]. 2021 Jan 1 [cited 2022 Apr 10];37(Suppl 1):190. Available from: /pmc/articles/PMC7858730/
Neumann S, Rüffer A, Sachweh J, Biermann D, Herrmann J, Jerosch-Herold M, et al. Narrative review of Ebstein’s anomaly beyond childhood: Imaging, surgery, and future perspectives. Cardiovascular diagnosis and therapy [Internet]. 2021 Dec 1 [cited 2022 Apr 10];11(6):1310–23. Available from: https://pubmed.ncbi.nlm.nih.gov/35070800/
Jui E, Singampalli KL, Shani K, Ning Y, Connell JP, Birla RK, et al. The Immune and Inflammatory Basis of Acquired Pediatric Cardiac Disease. Frontiers in cardiovascular medicine [Internet]. 2021 Jul 27 [cited 2022 Apr 10];8. Available from: https://pubmed.ncbi.nlm.nih.gov/34386532/
Murni IK, Musa NL. The Need for Specialized Pediatric Cardiac Critical Care Training Program in Limited Resource Settings. Frontiers in pediatrics [Internet]. 2018 Mar 14 [cited 2022 Apr 10];6. Available from: https://pubmed.ncbi.nlm.nih.gov/29594089/
Murni IK, Djer MM, Yanuarso PB, Putra ST, Advani N, Rachmat J, et al. Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Annals of Pediatric Cardiology [Internet]. 2019 Jan 1 [cited 2022 Apr 10];12(1):38. Available from: /pmc/articles/PMC6343386/
Lurz P, Unterhuber M, Rommel KP, Kresoja KP, Kister T, Besler C, et al. Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Repair and Implications of Interventional Closure. JACC Cardiovascular interventions [Internet]. 2021 Dec 27 [cited 2022 Apr 10];14(24):2685–94. Available from: https://pubmed.ncbi.nlm.nih.gov/34949392/
Restin T, Schmugge M, Cushing MM, Haas T. Comparison between intraoperative bleeding score and ROTEM® measurements to assess coagulopathy during major pediatric surgery. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis [Internet]. 2021 Oct 1 [cited 2022 Apr 10];60(5). Available from: https://pubmed.ncbi.nlm.nih.gov/34215519/
Bartoszko J, Karkouti K. Managing the coagulopathy associated with cardiopulmonary bypass. Journal of Thrombosis and Haemostasis [Internet]. 2021 Mar 1 [cited 2022 Apr 11];19(3):617–32. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.15195
Milas BL, Jobes DR, Gorman RC. Management of bleeding and coagulopathy after heart surgery. Seminars in thoracic and cardiovascular surgery [Internet]. 2000 [cited 2022 Apr 11];12(4):326–36. Available from: https://pubmed.ncbi.nlm.nih.gov/11154728/
Levi M, E.Cromheecke M, Jonge E de, Prins MH, Mol BJM de, Briët E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: Meta-analysis of clinically relevant endpoints. Transfus Altern Transfus Med [Internet]. 2001;3(5):13–22. Available from: http://dx.doi.org/10.1111/j.1778-428x.2001.tb00045.x
Kuepper F, Dangas G, Mueller-Chorus A, Kulka PM, Zenz M, Wiebalck A. Fibrinolytic activity and bleeding after cardiac surgery with cardiopulmonary bypass and low-dose aprotinin therapy. Blood Coagul Fibrinolysis [Internet]. 2003;14(2):147–53. Available from: http://dx.doi.org/10.1097/00001721-200302000-00005
Fitzgerald J, Lenihan M, Callum J, McCluskey SA, Srinivas C, van Rensburg A, et al. Use of prothrombin complex concentrate for management of coagulopathy after cardiac surgery: a propensity score matched comparison to plasma. British journal of anaesthesia [Internet]. 2018 May 1 [cited 2023 Apr 11];120(5):928–34. Available from: https://pubmed.ncbi.nlm.nih.gov/29661410/
Bartoszko J, Karkouti K. Can predicting transfusion in cardiac surgery help patients? British journal of anaesthesia [Internet]. 2017 Sep 1 [cited 2022 Apr 11];119(3):350–2. Available from: https://pubmed.ncbi.nlm.nih.gov/28969324/
Kunz SA, Miles LF, Ianno DJ, Mirowska-Allen KL, Matalanis G, Bellomo R, et al. The effect of protamine dosing variation on bleeding and transfusion after heparinisation for cardiopulmonary bypass. Perfusion [Internet]. 2018 Sep 15 [cited 2022 Apr 11];33(6):445–52. Available from: https://pubmed.ncbi.nlm.nih.gov/29544405/
Karkouti K, Ho LTS. Preventing and managing catastrophic bleeding during extracorporeal circulation. Hematology American Society of Hematology Education Program [Internet]. 2018 Nov 30 [cited 2023 Apr 11];2018(1):522–9. Available from: https://pubmed.ncbi.nlm.nih.gov/30504353/
Sebastian R, Ahmed MI. Blood conservation and hemostasis management in pediatric cardiac surgery. Front Cardiovasc Med [Internet]. 2021; 8:689623. Available from: http://dx.doi.org/10.3389/fcvm.2021.689623
Gottlieb EA, Andropoulos DB. Current and future trends in coagulation management for congenital heart surgery. The Journal of thoracic and cardiovascular surgery [Internet]. 2017 Jun 1 [cited 2023 Apr 18];153(6):1511–5. Available from: https://pubmed.ncbi.nlm.nih.gov/28314527/
Aggarwal NK, Subramanian A. Antifibrinolytics and Cardiac Surgery: The Past, The Present, and The Future. Annals of Cardiac Anaesthesia [Internet]. 2020 Apr 1 [cited 2023 Apr 18];23(2):193. Available from: /pmc/articles/PMC7336973/
Ellsworth P, Ma A. Factor-mimetic and rebalancing therapies in hemophilia A and B: the end of factor concentrates? Hematology American Society of Hematology Education Program [Internet]. 2021 Dec 10 [cited 2023 Apr 18];2021(1):219–25. Available from: https://pubmed.ncbi.nlm.nih.gov/34889356/
Surma S, Banach M. Fibrinogen and Atherosclerotic Cardiovascular Diseases-Review of the Literature and Clinical Studies. International journal of molecular sciences [Internet]. 2021 Jan 1 [cited 2022 Apr 18];23(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35008616/
Hofer S, Schlimp CJ, Casu S, Grouzi E. Management of Coagulopathy in Bleeding Patients. Journal of clinical medicine [Internet]. 2021 Jan 1 [cited 2023 Apr 18];11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35011742/
Despotis G, Eby C, Lublin DM. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion [Internet]. 2008 Mar [cited 2022 Apr 18];48(SUPPL. 1):2S-30S. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1537-2995.2007.01573.x
Bartoszko J, Karkouti K. Managing the coagulopathy associated with cardiopulmonary bypass. J Thromb Haemost [Internet]. 2021;19(3):617–32. Available from: http://dx.doi.org/10.1111/jth.15195
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 author

This work is licensed under a Creative Commons Attribution 4.0 International License.
