Skip to main content
Journal cover image

A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD.

Publication ,  Journal Article
Thompson, EJ; Foote, HP; Li, JS; Rotta, AT; Goldenberg, NA; Hornik, CP
Published in: Cardiol Young
January 2022

OBJECTIVES: To determine the optimal antithrombotic agent choice, timing of initiation, dosing and duration of therapy for paediatric patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We used PubMed and EMBASE to systematically review the existing literature of clinical trials involving antithrombotics following cardiac surgery from 2000 to 2020 in children 0-18 years. Studies were assessed by two reviewers to ensure they met eligibility criteria. RESULTS: We identified 10 studies in 1929 children across three medications classes: vitamin K antagonists, cyclooxygenase inhibitors and indirect thrombin inhibitors. Four studies were retrospective, five were prospective observational cohorts (one of which used historical controls) and one was a prospective, randomised, placebo-controlled, double-blind trial. All included were single-centre studies. Eight studies used surrogate biomarkers and two used clinical endpoints as the primary endpoint. There was substantive variability in response to antithrombotics in the immediate post-operative period. Studies of warfarin and aspirin showed that laboratory monitoring levels were frequently out of therapeutic range (variably defined), and findings were mixed on the association of these derangements with bleeding or thrombotic events. Heparin was found to be safe at low doses, but breakthrough thromboembolic events were common. CONCLUSION: There are few paediatric prospective randomised clinical trials evaluating antithrombotic therapeutics post-cardiac surgery; most studies have been observational and seldom employed clinical endpoints. Standardised, validated endpoints and pragmatic trial designs may allow investigators to determine the optimal drug, timing of initiation, dosing and duration to improve outcomes by limiting post-operative morbidity and mortality related to bleeding or thrombotic events.

Duke Scholars

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

January 2022

Volume

32

Issue

1

Start / End Page

10 / 20

Location

England

Related Subject Headings

  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Observational Studies as Topic
  • Humans
  • Fibrinolytic Agents
  • Child
  • Cardiovascular System & Hematology
  • Cardiopulmonary Bypass
  • Cardiac Surgical Procedures
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Thompson, E. J., Foote, H. P., Li, J. S., Rotta, A. T., Goldenberg, N. A., & Hornik, C. P. (2022). A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD. Cardiol Young, 32(1), 10–20. https://doi.org/10.1017/S1047951121005205
Thompson, Elizabeth J., Henry P. Foote, Jennifer S. Li, Alexandre T. Rotta, Neil A. Goldenberg, and Christoph P. Hornik. “A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD.Cardiol Young 32, no. 1 (January 2022): 10–20. https://doi.org/10.1017/S1047951121005205.
Thompson EJ, Foote HP, Li JS, Rotta AT, Goldenberg NA, Hornik CP. A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD. Cardiol Young. 2022 Jan;32(1):10–20.
Thompson, Elizabeth J., et al. “A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD.Cardiol Young, vol. 32, no. 1, Jan. 2022, pp. 10–20. Pubmed, doi:10.1017/S1047951121005205.
Thompson EJ, Foote HP, Li JS, Rotta AT, Goldenberg NA, Hornik CP. A systematic review of the evidence supporting post-operative antithrombotic use following cardiopulmonary bypass in children with CHD. Cardiol Young. 2022 Jan;32(1):10–20.
Journal cover image

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

January 2022

Volume

32

Issue

1

Start / End Page

10 / 20

Location

England

Related Subject Headings

  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Observational Studies as Topic
  • Humans
  • Fibrinolytic Agents
  • Child
  • Cardiovascular System & Hematology
  • Cardiopulmonary Bypass
  • Cardiac Surgical Procedures