Are we satisfied with conventional thromboprophylaxis after univentricular repair?

Dmitriy K. Guschin, Aleksey A. Kupryashov, Mikhail M. Zelenikin, Artem B. Nikiforov, Ivan T. Narmaniya, Anastasiya V. Scherbak, Denis A. Dibin

National scientific and practical center for cardiovascular surgery named after A.N. Bakulev of the Ministry of health of the Russian Federation, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

OBJECTIVE. The aim of this study is to analyze influence of conventional thromboprophylaxis for time- and space-resolved indices of thrombin generation and fibrin clot growth in children after staged univentricular repair.

METHODS. A prospective analysis was undertaken of 18 patients in median age 26 months after staged univentricular repair. The evalution of time- and space-resolved indices of thrombin generation and fibrin clot growth realized in Thrombodynamics Analyser (Hemacore LLC, Moscow, Russia). The collection and analysis of blood samples was carried out at the following endpoints: 1. The initial state; 2. Postoperative, first day of heparin prophylaxis (24 hours after the end of cardiopulmonary bypass); 3. Second day of heparin prophylaxis (48 hours after the end of cardiopulmonary bypass); 4. When the INR is reached within 2-3 for patients on warfarin prophylaxis (n=7) or 48 hours after the start of aspirin prophylaxis (n=11).

RESULTS. Early prophylaxis with heparin or warfarin significant supressed the majority indices of thrombin generation and fibrin clot growth. Despite this hypocoagulation was achieved only in 55.6% for heparin and 57.1% for warfarin and in the remaining cases either normo- or hypercoagulation was observed. No significant changes were observed in either indices of thrombin generation and fibrin clot growth for early prophylaxis with aspirin.

CONCLUSIONS. Thrombodinamics is an effective method for revealing coagulation disturbances after univentricular repair and useful option for postoperative thromboprophylaxis protocol. Conventional thromboprophylaxis approach is not effective in this cohort and further investigation have to be continued.