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Lower incidence of procoagulant abnormalities during follow-up after creation of the Fontan circulation in children.

Rask, Olof LU ; Hanséus, Katarina LU ; Ljung, Rolf LU ; Strandberg, Karin LU and Berntorp, Erik LU (2009) In Cardiology in the Young 19. p.152-158
Abstract
OBJECTIVE: Children who undergo surgery for complex congenital cardiac disease are reported to be at increased thrombotic risk. Our aim was to evaluate long-term changes in the haemostatic system after surgery, to compare markers of activated coagulation in children having surgery with those in a healthy control population, and to relate them to adverse clinical outcome.Patients and methodsWe studied, prior to surgery, the coagulation profiles of a cohort of 28 children admitted for a modified Fontan operation, studying them again after a period of mean follow-up of 9.6 years. Median age at the time of final surgery was 18.5 months, with a range from 12 to 76 months. We compared generation of thrombin, and levels of the activated protein... (More)
OBJECTIVE: Children who undergo surgery for complex congenital cardiac disease are reported to be at increased thrombotic risk. Our aim was to evaluate long-term changes in the haemostatic system after surgery, to compare markers of activated coagulation in children having surgery with those in a healthy control population, and to relate them to adverse clinical outcome.Patients and methodsWe studied, prior to surgery, the coagulation profiles of a cohort of 28 children admitted for a modified Fontan operation, studying them again after a period of mean follow-up of 9.6 years. Median age at the time of final surgery was 18.5 months, with a range from 12 to 76 months. We compared generation of thrombin, and levels of the activated protein C-protein C inhibitor complex to controls at follow-up. Thrombophilia and clinical outcome were evaluated. RESULTS: At long-term follow-up, a lower incidence of procoagulant abnormalities was observed compared to that before surgery. Of 27 patients, 3 (11%), but none of 45 controls, had levels of activated protein C-protein C inhibitor complex above the reference range. There were no significant differences in generation of thrombin between patients and controls. No thrombotic events were recorded, and the patients were generally in good clinical condition. CONCLUSIONS: Overall, haemostasis appeared to be in balance, and less prothrombotic, after surgery. A subset of the cohort did show indications of activated coagulation. The current therapeutic approach seems to be sufficient to protect the majority of patient. New tests of global coagulation, nonetheless, may be helpful in improving identification of individuals at increased thrombotic risk. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cardiology in the Young
volume
19
pages
152 - 158
publisher
Cambridge University Press
external identifiers
  • wos:000264966700006
  • pmid:19195416
  • scopus:66149136876
ISSN
1467-1107
DOI
10.1017/S1047951109003503
language
English
LU publication?
yes
id
6ee1cb39-c4bb-473a-a582-7de2d328b0bc (old id 1302851)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19195416?dopt=Abstract
date added to LUP
2009-03-02 16:14:05
date last changed
2017-01-01 07:40:32
@article{6ee1cb39-c4bb-473a-a582-7de2d328b0bc,
  abstract     = {OBJECTIVE: Children who undergo surgery for complex congenital cardiac disease are reported to be at increased thrombotic risk. Our aim was to evaluate long-term changes in the haemostatic system after surgery, to compare markers of activated coagulation in children having surgery with those in a healthy control population, and to relate them to adverse clinical outcome.Patients and methodsWe studied, prior to surgery, the coagulation profiles of a cohort of 28 children admitted for a modified Fontan operation, studying them again after a period of mean follow-up of 9.6 years. Median age at the time of final surgery was 18.5 months, with a range from 12 to 76 months. We compared generation of thrombin, and levels of the activated protein C-protein C inhibitor complex to controls at follow-up. Thrombophilia and clinical outcome were evaluated. RESULTS: At long-term follow-up, a lower incidence of procoagulant abnormalities was observed compared to that before surgery. Of 27 patients, 3 (11%), but none of 45 controls, had levels of activated protein C-protein C inhibitor complex above the reference range. There were no significant differences in generation of thrombin between patients and controls. No thrombotic events were recorded, and the patients were generally in good clinical condition. CONCLUSIONS: Overall, haemostasis appeared to be in balance, and less prothrombotic, after surgery. A subset of the cohort did show indications of activated coagulation. The current therapeutic approach seems to be sufficient to protect the majority of patient. New tests of global coagulation, nonetheless, may be helpful in improving identification of individuals at increased thrombotic risk.},
  author       = {Rask, Olof and Hanséus, Katarina and Ljung, Rolf and Strandberg, Karin and Berntorp, Erik},
  issn         = {1467-1107},
  language     = {eng},
  pages        = {152--158},
  publisher    = {Cambridge University Press},
  series       = {Cardiology in the Young},
  title        = {Lower incidence of procoagulant abnormalities during follow-up after creation of the Fontan circulation in children.},
  url          = {http://dx.doi.org/10.1017/S1047951109003503},
  volume       = {19},
  year         = {2009},
}