Thrombin generation in paediatric patients with congenital heart disease^[*]

Summary

Thrombin generation was studied in paediatric patients with congenital heart disease (CHD) undergoing cardiac surgery using the calibrated automated thrombography (CAT) in terms of the lag time until the onset of thrombin formation, time to thrombin peak maximum (TTP), endogenous thrombin potential (ETP), and thrombin peak height. The suitability to determine the coagulation status of these patients was investigated. Patients, material, methods: CAT data of 40 patients with CHD (age range from newborn to 18 years) were compared to data using standard coagulation parameters such as prothrombin (FII), antithrombin (AT), tissue factor pathway inhibitor (TFPI), prothrombin fragment 1.2 (F 1.2), thrombin-antithrombin (TAT), activated partial thromboplastin time (aPTT), and prothrombin time (PT). Results: A significant positive correlation was seen between ETP and FII (p < 0.01; r = 0.369), as well as between peak height and F II (p < 0.01; r = 0.483). A significant negative correlation was seen between ETP and TFPI values (p < 0.05; r = –0.225) while no significant correlation was seen between peak height and TFPI. A significant negative correlation was seen between F 1.2 generation and ETP (p < 0.05; r = –0.254) and between F 1.2 generation and peak height (p < 0.05; r = –0.236). No correlation was seen between AT and ETP or peak. Conclusions: CAT is a good global test reflecting procoagulatory and inhibitory factors of the haemostatic system in paediatric patients with CHD.

Zusammenfassung

Wir untersuchten die Thrombinentstehung bei Kindern mit angeborenen Herzfehlern rund um Herzoperation, um den Einsatz eines neuen Gerätes (CAT) zu evaluieren, das eine automatische Dokumentation der Thrombinentstehung ermöglicht. Marker sind die Gerinnungszeit bis zum Eintreten der Thrombinentstehung, die Zeit bis zum Thrombinmaximum (TTP), das endogene Thrombinpotential (ETP) und die maximale Höhe des Thrombinbursts. Patienten, Material, Methoden: Wir untersuchten 40 Kinder mit angeborenen Herzfehlern vom Neugeborenen- bis ins Jugendalter. Unsere CAT-Daten haben wir verglichen mit Messgrößen wie FII, AT, F 1.2, TFPI und aPTT. Ergebnisse: Wir fanden eine positive Korrelation zwischen ETP und FII sowie zwischen der maximalen Höhe des Thrombinbursts und FII. Eine negative Korrelation zeigte sich zwischen ETP und TFPI, zwischen F 1.2 und ETP sowie zwischen F 1.2 und maximaler Höhe des Thrombinbursts. Keine Korrelation sahen wir zwischen TFPI und maximaler Höhe des Thrombinbursts sowie zwischen AT und ETP. Schlussfolgerung: Das neue CAT spiegelt die pro- und antikoagulatorischen Faktoren des Gerinnungssystems bei Kindern mit angeborenen Herzfehlern gut wider. Es eignet sich daher als globaler Test.

Schlüsselwörter

Kalibrierte automatisierte Thrombographie - Thrombinentstehung - endogenes Thrombinpotenzial - Prothrombin - Herzoperation - angeborene Herzfehler

Keywords

Calibrated automated thrombography - thrombin generation - endogenous thrombin potential - prothrombin - cardiac surgery - congenital heart disease

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