Hypercoagulability panel testing predicts thrombosis in neonates undergoing cardiac surgery
Hypercoagulability panel testing predicts thrombosis in neonates undergoing cardiac surgery
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DOI：
10.1002/ajh.23607
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发表时间：
2014-02-01
影响因子：
12.8
通讯作者：
Emani, Sitaram M.
中科院分区：
文献类型：
--
作者：
Emani, Sirisha;Zurakowski, David;Emani, Sitaram M.
血栓形成是心脏手术后新生儿发病率和死亡率的原因之一。心脏手术后止血因子的变化已有报道，但尚无数据将这些变化与新生儿血栓形成风险相关。本研究的目的是通过评估一组高凝指标来预测接受心脏手术的新生儿血栓形成。接受心脏手术的新生儿在术前入组并进行前瞻性随访。术前高凝状态检查包括凝血酶生成试验（TGA）、抗凝血酶III、蛋白C、蛋白S、因子VIII、凝血酶激活纤溶抑制物（TAFI）、纤溶酶原激活物抑制物-1（派-1）和心磷脂抗体的免疫测定。术后血栓形成由临床事件（分流血栓形成、肢体缺血和卒中）或影像学（血管内或心内血栓）定义。评估血栓形成的风险因素。在为期两年的研究中，有100名新生儿入组。术后院内血栓形成的发生率为20%。与血栓形成相关的唯一显著临床风险因素是单心室生理学。单变量分析显示，与血栓形成风险增加相关的高凝因素为派-1、TAFI和TGA升高以及抗心磷脂抗体的存在。多因素Logistic回归分析显示派-1（P=0.015）、TAFI（P=0.028）和TGA（P=0.007）升高是血栓形成的独立预测因素。高凝性小组测试可能有助于确定新生儿在心脏手术后血栓形成的高风险。未来的研究是必要的，以确定高风险患者是否受益于靶向抗凝治疗。Am.血液学杂志89：151-155，2014. (c)2013 Wiley Periodicals，Inc.
Thrombosis contributes to morbidity and mortality in neonates following cardiac surgery. Alterations in hemostatic factors following cardiac surgery have been described, but there is no data correlating these changes with risk of thrombosis in neonates. The aim of this study is to predict thrombosis in neonates undergoing cardiac surgery by assessment of a panel of hypercoagulability markers. Neonates undergoing cardiac surgery were enrolled preoperatively and prospectively followed. Preoperative hypercoagulability panel testing included thrombin generation assay (TGA), immunoassays for antithrombin III, protein C, protein S, factor VIII, thrombin-activatable fibrinolytic inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1), and cardiolipin antibody. Postoperative thrombosis was defined by clinical events (shunt thrombosis, limb ischemia, and stroke) or imaging (intravascular or intracardiac thrombus). Risk factors for thrombosis were assessed. One hundred neonates were enrolled in the study over a two-year period. The incidence of postoperative in-hospital thrombosis was 20%. The only significant clinical risk factor associated with thrombosis was the single ventricle physiology. Hypercoagulability factors associated with increased risk of thrombosis by univariate analysis were elevated PAI-1, TAFI, and TGA, and presence of anticardiolipin antibodies. Multivariable logistic regression analysis demonstrated that elevated PAI-1 (P=0.015), TAFI (P=0.028), and TGA (P=0.007) were independent predictors of thrombosis. Hypercoagulability panel testing may help identify neonates at high risk for thrombosis following cardiac surgery. Future studies are warranted to determine if high risk patients benefit from targeted anticoagulation therapies. Am. J. Hematol. 89:151-155, 2014. (c) 2013 Wiley Periodicals, Inc.