• Alessandra Rizza, Giovina Di Felice, Rosa Luciano, Ottavia Porzio, Ombretta Panizzon, Maurizio Muraca, and Paola Cogo.
• Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Cardiac Anesthesia/Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165 Roma, Italy. Electronic address: alessandra.rizza1@virgilio.it.
• Thromb. Res. 2017 Dec 1; 160: 91-96.

IntroductionImpaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB.Materials And MethodsProspective observational study performed in children aged <24months undergoing cardiac surgery with CPB. Exclusion criteria were preoperative coagulopathy or anticoagulant therapy. Coagulation was evaluated by standard coagulation assays (prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count), TEG, CAT and PPL at anaesthesia induction (T1) and after 12h (T2). Perioperative bleeding management was performed according to the institutional guidelines.ResultsForty-nine children aged <24months were enrolled. At T1 ETP and peak height evaluated by CAT were significantly lower in infants aged <6months. Standard coagulation tests, TEG and PPL did not correlate with age. At T2 platelet count, plasmatic fibrinogen level, all TEG parameters, ETP and peak height by CAT were significantly impaired compared to baseline values (T1), despite allogeneic blood product transfusions.ConclusionsThrombin generation is significantly impaired in children affected by congenital heart disease, compared to healthy children and adults. CAT parameters resulted age-dependent, and thrombin generation is lower in infants aged <6months. After cardiac surgery with CPB, a coaugulopathy, revealed by CAT, TEG, but not by PT and aPTT assays, is persistent 12h after surgery despite transfusions of blood products.Copyright © 2017 Elsevier Ltd. All rights reserved.

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