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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 ,
Zuzana Laluhova-Striezencova  and
Martin Zahorec
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
*
Correspondence to: Nina Hakacova, Cardiac Intensive Care Unit, Department of Pediatric Cardiology, Pediatric Cardiac Centre, Limbova 1, 544 01 Bratislava, Slovakia. Tel: 043 593 71 255; Fax: 919 668 7079; E-mail: nina.hakacova@gmail.com
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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.

Keywords

Coagulation abnormalitiescoagulation factorsnewbornscongenital heart diseasethrombosis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 397 - 401
Copyright
Copyright © Cambridge University Press 2008

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