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High acetylsalicylic acid dosing in infants after modified Blalock–Taussig shunt

Published online by Cambridge University Press:  11 February 2019

Arun Saini ,
Ashwini D. Joshi ,
Krista M. Cowan ,
Connor Wayne Gatewood ,
Susheel T. K. Kumar ,
Jerry Allen ,
Samir H. Shah ,
Simonne S. Nouer ,
Tamekia Jones  and
Christopher J. Knott-Craig
...Show all authors
Arun Saini*
Affiliation:
Division of Pediatric CriticalCare Medicine, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Ashwini D. Joshi
Affiliation:
School of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
Krista M. Cowan
Affiliation:
School of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
Connor Wayne Gatewood
Affiliation:
School of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
Susheel T. K. Kumar
Affiliation:
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
Jerry Allen
Affiliation:
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
Samir H. Shah
Affiliation:
Division of Pediatric CriticalCare Medicine, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
Simonne S. Nouer
Affiliation:
Department of Pediatrics and Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
Tamekia Jones
Affiliation:
Department of Pediatrics and Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
Christopher J. Knott-Craig
Affiliation:
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
Umar S. Boston
Affiliation:
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
*
Author for correspondence: A. Saini, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, 6651 Main street, MC E1420, Houston, TX, 77030, USA. Tel: +1 8238259478; Fax: +1 8328255929; E-mail: asaini@bcm.edu
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Abstract

Objective

Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.

Methods

In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.

Results

There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.

Conclusions

High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.

Keywords

Modified Blalock–Taussig shuntred blood cell transfusionshunt thrombosisshunt interventionsingle ventricular physiologyaspirincyanotic congenital heart lesiontransfusion-related adverse eventsacetylsalicylic acid
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 389 - 397
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Saini A, Joshi AD, Cowan KM, Wayne Gatewood C, Kumar STK, Allen J, Shah SH, Nouer SS, Jones T, Knott-Craig CJ, Boston US. (2019) High acetylsalicylic acid dosing in infants after modified Blalock–Taussig shunt. Cardiology in the Young29: 389–397. doi: 10.1017/S1047951118002536

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