Background: Patients undergoing cardiac surgery requiring cardiopulmonary bypass and mechanical circulatory assistance in the immediate postoperative period may experience a series of changes in hemostasis.

Aims: To report a clinical case of postoperative heart transplantation with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction, presenting changes in hemostasis and fibrinolysis.

Methods: The information contained in this work was obtained by reviewing medical records, interviewing with the patient, photographic record of the methods diagnoses to which the patient was submitted and literature revision.

Results: Patient, female, 4 years old, with congenital heart disease, who underwent a heart transplant requiring extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction. Presenting massive pulmonary hemorrhage on the 12th PO, with an urgent surgical approach to control hemostasis. During a surgical approach, she presented an incoagulable coagulogram, with an RNI 7.3, fibrinogen 131mg/dl and a significant drop in hemoglobin from 11 to 5g/dl. Evolving with hemodynamic instability and severe general condition. Red blood cell and platelet concentrate, cryoprecipitate, tranexamic acid, prothrombin complex concentrate and protamine were necessary to control hemostasis. Thromboelastogram was performed showing an increase in CFT (clot formation time),195 seconds, suggesting platelet deficiency or fibrinogen. After hemodynamic stability, Prescribed tranexamic acid by continuous infusion for five days until pulmonary surgical approach, with no complications, with adequate control of hemostasis. Thromboelastogram was performed again, showing CT (clotting time), 65 seconds, and CFT (clot formation time), 135 seconds, within normal values.

Conclusions: Risk factors such as longer mechanical circulatory support time and reduced platelet count increase the incidence of excessive bleeding in this age group. Changes in the control of hemostasis in the intraoperative and early postoperative periods occur as a consequence of the activation of the coagulation cascade and fibrinolysis, being still a challenge in clinical practice in view of the need for emergency measures.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pediatric-heart-transplantation-and-mechanical-circulatory-assistance-a-challenge-for-hemostasis/