Low Preoperative Antithrombin Activity Is Associated with Increased Red Cell and Plasma Transfusion during Neonatal and Infant Cardiac Surgery

Z.A. Fang¹, E. Gottlieb², E. Menard³, D. Vener⁴, V. Kostousov⁵, K. Bruzdoski⁵, L. Hensch⁵, S.R. Hui⁵, J. Teruya⁵

¹Hospital for Sick Children, Department of Anesthesiology and Pain Medicine, Toronto, Canada, ²Dell Children's Medical Center, Department of Surgery and Perioperative Care, Austin, United States, ³Texas Children’s Hospital, Anesthesiology, Houston, United States, ⁴Texas Children's Hospital, Baylor College of Medicine, Anesthesiology, Houston, United States, ⁵Texas Children's Hospital, Baylor College of Medicine, Transfusion Medicine & Coagulation, Houston, United States

Abstract Number: PB0280

Meeting: ISTH 2020 Congress

Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative

Background: Heparin is most commonly used in cardiac surgery; however, neonates and infants have physiologically low antithrombin (AT) level. Low AT could increase needs for transfusion of plasma due to inadequate anticoagulation on cardiopulmonary bypass (CPB).

Aims: This study is to examine the influence of AT level on the transfusion requirements and coagulation markers of neonates and infants undergoing open heart surgery.

Methods: This is a prospective, observational study, approved by IRB. Neonates and infants < 6 months of age undergoing cardiac surgery with CPB were enrolled. Demographic, intraoperative, and transfusion data were collected. Preoperative AT and thrombin antithrombin complex (TAT) levels were measured after induction of anesthesia. Prior to separation from CPB, AT, TAT, D-dimer, fibrin monomers (FM), and anti-Xa were measured. Data are presented as median and interquartile ranges (IQR). Linear regression analyses were performed to examine preoperative AT
(pre-AT) levels and postoperative transfusion requirements and coagulation markers. Stata 15 was used for statistical analysis.

Results: A total of 60 patients were included. The age at surgery was 23.5 days (8.5, 99), weight 3.92 kg (3.25, 5.25) and CPB time was 161 min (123, 205). Pre-AT was associated with age (r=0.75; p< 0.001) and body weight,
(r=0.73; p< 0.001). Mean pre-AT level was 65% (55, 84) and increased to 81% (73, 93), p< 0.001 postoperatively. Using linear regression, lower pre-AT level was significantly associated with increased transfusion of red blood cells (RBC), coefficient -1.21 (95%CI, -1.57 to -0.85; p< 0.001) and plasma, coefficient -0.95 (95%CI, 1.28 to -0.62; p< 0.001) during CPB (Figure). Anti-Xa level was significantly associated with postoperative AT (post-AT) level, however, there were no associations between TAT, D-dimer, FM and pre- or post-AT levels.

Conclusions: Low pre-AT level is significantly associated with increased RBC and plasma transfusion on CPB in neonates and infants undergoing congenital heart surgery.

[Correlation between antithrombin level and red cells or plasma]

To cite this abstract in AMA style:

Fang ZA, Gottlieb E, Menard E, Vener D, Kostousov V, Bruzdoski K, Hensch L, Hui SR, Teruya J. Low Preoperative Antithrombin Activity Is Associated with Increased Red Cell and Plasma Transfusion during Neonatal and Infant Cardiac Surgery [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/low-preoperative-antithrombin-activity-is-associated-with-increased-red-cell-and-plasma-transfusion-during-neonatal-and-infant-cardiac-surgery/. Accessed December 6, 2023.

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