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Disturbances of coagulation in neonates with functionally univentricular physiology prior to the first stage of surgical reconstruction

Published online by Cambridge University Press:  01 August 2008

Nina Hakacova
Affiliation:
Cardiac Intensive Care Unit, Department of Pediatric Cardiology, Pediatric Cardiac Centre, Bratislava, Slovakia
Zuzana Laluhova-Striezencova
Affiliation:
Department of Clinical Hematology, Children’s University Hospital, Bratislava, Slovakia
Martin Zahorec
Affiliation:
Cardiac Intensive Care Unit, Department of Pediatric Cardiology, Pediatric Cardiac Centre, Bratislava, Slovakia
Corresponding
E-mail address:

Abstract

Background

Altered levels of coagulation factors are reported in patients with functionally univentricular physiology before and following the second and third stages of reconstructive surgery. The aims of our study were to determine if such abnormalities are also present in newborns with this physiology prior to the first stage of surgical treatment.

Patients and methods

We studied 20 neonates with functionally univentricular physiology admitted to the Children’s Cardiac Centre in Slovakia, using 20 healthy neonates as age-matched controls. Demographic characteristics, and concentration of liver enzymes, serum albumin, and complete blood count, did not differ between the two groups. Concentrations of Factor II, V, VII, VIII, Protein C, Protein S and Antithrombin were compared between the groups, and assessed as variable factors for coagulation.

Results

In those with functionally univentricular physiology, procoagulation Factor II (p < 0.001), VII (p < 0.001), VIII (p < 0.01), anticoagulation Protein C (p < 0.001), Protein S (p < 0.001) and Antitrombin III (p < 0.001) all were present in significantly lower values compared with findings in the control group. D-dimer (p < 0.0001) and Fibrin Degradation Products (p < 0.0001) were present at significantly higher levels, but the concentration of plasminogen was significantly lower (p < 0.0001). The activated partial thromboplastin time (p < 0.012), and the prothrombin time (p < 0.0001), was significantly prolonged in those with functionally univentricular physiology compared with their controls.

Conclusion

The presence of abnormal coagulation factors, markers of thrombolysis in the plasma, and increased risk of bleeding, suggests activation of haemostasis, and consumption of factors responsible for coagulation, in those with functionally univentricular physiology. The question arises whether the reported abnormalities are predictive of the known abnormalities of coagulation occurring during the second and third stages of surgical repair for patients with functionally univentricular hearts.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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References

1.Odegard, KC, McGowan, FX Jr, Zurakowski, D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 2003; 125: 12601267.CrossRefGoogle ScholarPubMed
2.Jacobs, ML. The Fontan operation, thromboembolism, and anticoagulation: a reappraisal of the single bullet theory. J Thorac Cardiovasc Surg 2005; 129: 491495.CrossRefGoogle ScholarPubMed
3.Marcelletti, CF, Iorio, FS, Abella, RF. Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1999; 2: 131142.CrossRefGoogle ScholarPubMed
4.Jahangiri, M, Shore, D, Kakkar, V, Lincoln, C, Shinebourne, E. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg 1997; 113: 989992; discussion 992-983.CrossRefGoogle ScholarPubMed
5.Odegard, KC, McGowan, FX Jr, Zurakowski, D, et al. Coagulation factor abnormalities in patients with single-ventricle physiology immediately prior to the Fontan procedure. Ann Thorac Surg 2002; 73: 17701777.CrossRefGoogle ScholarPubMed
6.Cholette, JM, Rubenstein, JS, Alfieris, GM, et al. Elevated risk of thrombosis in neonates undergoing initial palliative cardiac surgery. Ann Thorac Surg 2007; 84: 13201325.CrossRefGoogle ScholarPubMed
7.Monagle, P, Barnes, C, Ignjatovic, V, et al. Developmental haemostasis. Impact for clinical haemostasis laboratories. Thromb Haemost 2006; 95: 362372.Google ScholarPubMed
8.Cromme-Dijkhuis, AH, Henkens, CM, Bijleveld, CM, Hillege, HL, Bom, VJ, van der Meer, J. Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations. Lancet 1990; 336: 10871090.CrossRefGoogle ScholarPubMed
9.Andrew, M, Vegh, P, Johnston, M, Bowker, J, Ofosu, F, Mitchell, L. Maturation of the hemostatic system during childhood. Blood 1992; 80: 19982005.Google ScholarPubMed
10.Andrew, M, Paes, B, Milner, R, et al. Development of the human coagulation system in the full-term infant. Blood 1987; 70: 165172.Google ScholarPubMed
11.Sluysmans, T, Ovaert, C, d’Udekem, Y, Barrea, C. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg 1999; 117: 1038.CrossRefGoogle ScholarPubMed
12.Miller, GJ, Ireland, HA, Cooper, JA, et al. Relationship between markers of activated coagulation, their correlation with inflammation, and association with coronary heart disease (NPHSII). J Thromb Haemost 2008; 6: 259267.CrossRefGoogle Scholar
13.Procelewska, M, Kolcz, J, Januszewska, K, Mroczek, T, Malec, E. Coagulation abnormalities and liver function after hemi-Fontan and Fontan procedures – the importance of hemodynamics in the early postoperative period. Eur J Cardiothorac Surg 2007; 31: 866872.CrossRefGoogle ScholarPubMed

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