• J. Cardiothorac. Vasc. Anesth. · Aug 2020

    Observational Study

    Thrombin Generation and Antithrombin Activity in Infants Undergoing Cardiopulmonary Bypass-An Exploratory Study.

    • Elena Ashikhmina, Pamela M Johnson, Devon O Aganga, Gregory A Nuttall, Brian D Lahr, Hartzell V Schaff, and Joseph A Dearani.
    • Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address: ashikhmina.elena@mayo.edu.
    • J. Cardiothorac. Vasc. Anesth. 2020 Aug 1; 34 (8): 2083-2090.

    ObjectivesCoagulopathic bleeding is a major complication of pediatric cardiac surgery. Investigating perioperative dynamics of thrombin generation and antithrombin (AT) activity might provide more insight into the underlying mechanisms of coagulopathy. This can help develop a targeted hemostatic approach in the future. The authors hypothesized that there is a decline in both thrombin generation and AT activity in infants undergoing cardiopulmonary bypass (CPB).DesignProspective observational study.SettingSingle academic medical center.ParticipantsInfants <10 kg of weight undergoing cardiac surgery with CPB.InterventionsBlood specimen collection and testing.Measurements And ResultsThe authors performed assays of thrombin generation and AT activity on the samples of platelet-poor plasma of 25 infants, repeating them at 3 points: before CPB and heparinization, after separation from CPB and protamine administration, and after chest closure. The authors observed a statistically significant decline in thrombin generation shortly after separation from CPB compared with baseline. The geometric mean for lag time was prolonged (4.0 v 5.5 minutes, p = 0.013), and peak thrombin and the net amount of generated thrombin declined almost 3-fold (80.7 v 25.1 nmol, p < 0.001; 1264 v 476 nmol, p < 0.001, respectively). This was accompanied by a decline in AT activity (59.8 v 50.1, p = 0.001). After platelet and cryoprecipitate transfusion, at the case conclusion AT activity had recovered marginally (59.8 v 55.4, p = 0.042), but thrombin generation remained reduced.ConclusionsIn pediatric patients <10 kg undergoing cardiac surgery with CPB, thrombin generation and AT activity decline and do not recover completely after transfusion of platelets and cryoprecipitate.Copyright © 2019 Elsevier Inc. All rights reserved.

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