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- Ariane Willems, Philippe Patte, Françoise De Groote, and Philippe Van der Linden.
- Leids Universitair Medisch Centrum, Pediatric Intensive Care Unit, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: a.m.a.willems@lumc.nl.
- Transfus Apher Sci. 2019 Jun 1; 58 (3): 304-309.
ObjectivesCyanotic heart disease is associated with increased risk of bleeding in children undergoing cardiac surgery. We studied if the presence of a cyanotic heart disease was an independent predictive factor for fresh frozen plasma (FFP) and platelets transfusion in these patients. In children with ROTEM measurements, we also tried to characterize the coagulation profile between both groups.DesignRetrospective observational study.SettingTertiary university hospital; single center.ParticipantsAll consecutive children admitted for cardiac surgery with cardiopulmonary bypass (CPB) from January 2006 to December 2014. Patients who received FFP in the CPB priming were excluded. Multivariate logistic regression was used to determine the predictive factors for FFP and platelet transfusions.Interventionnone.Measurements And Main ResultsFrom the 1846 patients included for analysis: 1063 were acyanotic and 783 were cyanotic. The presence of cyanotic heart disease was an independent predicting factor for both FFP (OR: 2.09; 95%CI: 1.44-3.02) and platelets (OR:3.98; 95%CI: 2.28-6.70) transfusion. Cyanotic children exhibited also higher perioperative blood losses [Intraoperative: 31.1 (17.6-50.4) versus 26.7 (14.8-44.7); P < 0.001 and Postoperative: 31.2 (19.1-51.9) versus 16.9 (10.4-26.9); P < 0.001]. Thromboelastometry assays after separation from CPB and heparin reversal revealed more complex coagulation disturbances in cyanotic than acyanotic children.ConclusionChildren with a cyanotic heart disease are at higher risk of FFP and platelet transfusion after cardiac surgery. Intraoperative monitoring should be used to guide administration of blood and haemostatic product in this population at high risk of postoperative bleeding.Copyright © 2019 Elsevier Ltd. All rights reserved.
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