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Thromboelastography of Patients After Fontan Compared with Healthy Children

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Abstract

Patients who have undergone a Fontan procedure face an increased risk for thromboembolic complications. This study aimed to evaluate whether thromboelastography, a global whole-blood assay of coagulation, can be used to detect hypercoagulability in pediatric Fontan patients compared with healthy children. This prospective, cross-sectional study investigated 25 Fontan patients and 51 healthy children in three age groups: 1–5 years, 6–10 years, and 11–16 years. Kaolin-activated thromboelastography was performed on citrated samples. No statistically significant differences in thromboelastography parameters were found among the different age groups of the 51 healthy children. None of the 25 Fontan patients demonstrated evidence of hypercoagulability on thromboelastography (95% confidence interval, 0–7%), as defined by two standard deviations above or below the normal mean. The findings suggest that the percentage of Fontan patients demonstrating hypercoagulability on thromboelastography is substantially lower than the reported incidence of thromboembolic complications. Whether thromboelastography could be helpful in predicting patients at increased risk for thromboembolic complications or not still is not known. Further studies comparing the thromboelastography of Fontan patients with the thromboembolic complications of those without Fontan are needed to delineate these issues.

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Acknowledgment

This study was funded by an NIH/NHLBI K12 Mentored Career Development Award in Benign Hematology.

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Authors and Affiliations

  1. Division of Hematology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    Leslie Raffini

  2. University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    Alexander Schwed

  3. Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    X. Long Zheng & Maria Tanzer

  4. Division of Cardiac Anesthesia, Department of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    Susan Nicolson & David Jobes

  5. Division of Cardiothoracic Surgery, Department of Surgery, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    J. William Gaynor

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  1. Leslie Raffini
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  2. Alexander Schwed
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  3. X. Long Zheng
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  4. Maria Tanzer
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  5. Susan Nicolson
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  6. J. William Gaynor
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  7. David Jobes
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Correspondence to Leslie Raffini.

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Raffini, L., Schwed, A., Zheng, X.L. et al. Thromboelastography of Patients After Fontan Compared with Healthy Children. Pediatr Cardiol 30, 771–776 (2009). https://doi.org/10.1007/s00246-009-9434-1

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  • DOI: https://doi.org/10.1007/s00246-009-9434-1

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