Research Article
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Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates

Year 2019, Volume: 46 Issue: 1, 109 - 118, 03.03.2019
https://doi.org/10.5798/dicletip.534847

Abstract

Objective:
Cardiac catheterization is one of the basic procedures applied in the diagnosis
and treatment of cardiovascular diseases. Development of thrombosis is a
serious complication of catheterization. In this study, the frequency and the
factors affecting the development of arterial thrombosis were prospectively
evaluated in neonates who were subjected to diagnostic or interventional
cardiac catheterization.



Methods:
Twenty newborns that received femoral artery catheterization within 6-month
period were enrolled in this study. Blood samples were taken for complete blood
count, prothrombin, activated partial thromboplastin time, INR ratio and
mutations of factorV Leiden, prothrombin 20210A, methylenetetrahydrofolate
reductase C667T and A1298 before the procedure. 100 U/kg bolus of heparin was
infused during catheterization. 28 U/kg/hour infusion of heparin was given to
the patients with clinically suspected thrombosis during first few hours after
catheterization. Doppler ultrasonography was performed in all patients within 6
hours after catheterization.



Results:
The gestational age of patients ranged from 31 to 40 weeks (median 39). Mean
birth weight was 2996 ± 589 (1880-4000 gr). Arterial thrombosis was detected in
10 patients by Doppler USG. On development of arterial thrombosis, patient age,
gender, diagnosis, treatments, platelet count, hemoglobin, prothrombin and
activated partial thromboplastin time values, FactorV Leiden, prothrombin 20210A,
methylenetetrahydrofolate reductase C667T and A1298 mutations were found as not
impacting (p>0.05). Those who were found to have thrombosis in Doppler
ultrasonography had lower INR levels compared to others (p= 0.023).



Conclusions:
The rate of femoral arterial thrombosis in newborns after catheterization
detected by Doppler ultrasonography was 50% in this study. Our data suggest
that early clinical assessment for the diagnosis of thrombosis may be
misleading but Doppler ultrasonography may be helpful early detection. Further
studies are needed to prediction appropriate drugs and/or doses for prevention
of thrombosis after arterial catheterization in newborns.

References

  • 1. Glatz AC, Shah SS, McCarthy AL, et all. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study. CatheterCardiovascInterv. 2013; 82:454-62.
  • 2. Feltes TF, Bacha E, Beekman RH 3rd, et all; American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; American Heart Association. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2607-52.
  • 3. Roushdy AM1, Abdelmonem N, El Fiky AA. Factors affecting vascular access complications in children undergoing congenital cardiac catheterization. Cardiol Young. 2012; 22:136-44.
  • 4. Rizzi M, Albisetti M. Treatment of arterial thrombosis in children: Methods and mechanisms. Thromb Res. 2018; 169:113-9.
  • 5. Casa L.D.C, Ku D.N. Thrombus Formation at High Shear Rates. Annu Rev Biomed Eng.2017; 19:415-33.
  • 6. Giglia TM, Massicotte MP, Tweddell JS, et all; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Stroke Council. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2013; 128:2622-703.
  • 7. Mortezaiyan H, Aarabi-Moghadam M, Asadpour N, et all. Treatment of femoral artery thrombosis with streptokinase and heparin after cardiac catheterization. Res Cardiovasc Med. 2014;3:e13552.
  • 8. Avila ML, Shah PS, Brandão LR. Different unfractionated heparin doses for preventing arterial thrombosis in children undergoing cardiac catheterization. Cochrane Database Syst Rev. 2014; 3:CD010196.
  • 9. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Actaradiol. 1953; 39:368-76.
  • 10. Bulbul ZR, Galal MO, Mahmoud E, et all. Arterial complications following cardiac catheterization in children less than 10 kg. Asian CardiovascThorac Ann 2002; 10:129–32.
  • 11. Grady RM, Eisenberg PR, Bridges ND. Rational approach to use of heparin during cardiac catheterization in children. J Am CollCardiol 1995; 25:725–9.
  • 12. Girod DA, Hurwitz RA, Caldwell RL. Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization. PediatrCardiol 1982; 3:175–80.
  • 13. Laurin S, Lundstrom NR. Venous thrombosis after cardiac catheterization in infants. ActaRadiol 1987; 28:241–6.
  • 14. Miga DE, McKellar LF, Denslow S, et all. Incidence of femoral vein occlusion after catheter ablation in children: evaluation with magnetic resonance angiography. PediatrCardiol 1997; 18:204–7.
  • 15. Ruud E, Natvig S, Holmstrom H, Wesenberg F. Low prevalence of femoral venous thrombosis after cardiac catheterizations in children: a prospective study. Cardiol Young 2002; 12:513–8.
  • 16. Keane JF, Lang P, Newburger J, Fyler DC. Iliac vein-inferior caval thrombosis after cardiac catheterization in infancy. PediatrCardiol 1980; 1:257–61.
  • 17. Monagle P1. Anticoagulation in the young. Heart. 2004; 90:808-12.
  • 18. Brotschi B, Hug M, Kretschmar O, Rizzi M, Albisetti M. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart. 2015;101:948-53.
  • 19. Veldman A, Nold MF, Michel-Behnke I. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008; 4:1337–48.
  • 20. Hanslik A, Kitzmüller E, Thom K, et all. Incidence of thrombotic and bleeding complications during cardiac catheterization in children: comparison of high-dose vs. low-dose heparin protocols. J ThrombHaemost. 2011; 9:2353-60.
  • 21. Monagle P, Chalmers E,Chan A, et all. Antithrombotic therapy in children: American College Of Chest Physicians Evidence Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:887S-968S.
  • 22. Hanslik A, Kitzmüller E, Tran US, et all. Monitoring unfractionated heparin in children: a parallel-cohort randomized controlled trial comparing 2 dose protocols. Blood. 2015 29;126:2091-7.
  • 23. Heller C1, Nowak-Göttl U. Maternal thrombophilia and neonatal thrombosis. Best Pract Res ClinHaematol. 2003; 16:333-45.
  • 24. Kosch A, Kuwertz-Broking E, Heller C, et all. Renal venous thrombosis in neonates: prothrombotic risk factors and long-term followup. Blood 2004;104:1356–60
  • 25. Ghasemi A, Horri M, Salahshour Y. Coagulation Abnormalities in Pediatric Patients with Congenital Heart Disease: A Literature Review. International Journal of Pediatrics, 2014; 2:141-3.
  • 26. Tempe DK, Viramani S. Coagulation abnormalities in patients with cyanotic congenital heart disease. J CardiothoracVascAnesth 2002; 16:752-65.
Year 2019, Volume: 46 Issue: 1, 109 - 118, 03.03.2019
https://doi.org/10.5798/dicletip.534847

Abstract

References

  • 1. Glatz AC, Shah SS, McCarthy AL, et all. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study. CatheterCardiovascInterv. 2013; 82:454-62.
  • 2. Feltes TF, Bacha E, Beekman RH 3rd, et all; American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; American Heart Association. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2607-52.
  • 3. Roushdy AM1, Abdelmonem N, El Fiky AA. Factors affecting vascular access complications in children undergoing congenital cardiac catheterization. Cardiol Young. 2012; 22:136-44.
  • 4. Rizzi M, Albisetti M. Treatment of arterial thrombosis in children: Methods and mechanisms. Thromb Res. 2018; 169:113-9.
  • 5. Casa L.D.C, Ku D.N. Thrombus Formation at High Shear Rates. Annu Rev Biomed Eng.2017; 19:415-33.
  • 6. Giglia TM, Massicotte MP, Tweddell JS, et all; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Stroke Council. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2013; 128:2622-703.
  • 7. Mortezaiyan H, Aarabi-Moghadam M, Asadpour N, et all. Treatment of femoral artery thrombosis with streptokinase and heparin after cardiac catheterization. Res Cardiovasc Med. 2014;3:e13552.
  • 8. Avila ML, Shah PS, Brandão LR. Different unfractionated heparin doses for preventing arterial thrombosis in children undergoing cardiac catheterization. Cochrane Database Syst Rev. 2014; 3:CD010196.
  • 9. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Actaradiol. 1953; 39:368-76.
  • 10. Bulbul ZR, Galal MO, Mahmoud E, et all. Arterial complications following cardiac catheterization in children less than 10 kg. Asian CardiovascThorac Ann 2002; 10:129–32.
  • 11. Grady RM, Eisenberg PR, Bridges ND. Rational approach to use of heparin during cardiac catheterization in children. J Am CollCardiol 1995; 25:725–9.
  • 12. Girod DA, Hurwitz RA, Caldwell RL. Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization. PediatrCardiol 1982; 3:175–80.
  • 13. Laurin S, Lundstrom NR. Venous thrombosis after cardiac catheterization in infants. ActaRadiol 1987; 28:241–6.
  • 14. Miga DE, McKellar LF, Denslow S, et all. Incidence of femoral vein occlusion after catheter ablation in children: evaluation with magnetic resonance angiography. PediatrCardiol 1997; 18:204–7.
  • 15. Ruud E, Natvig S, Holmstrom H, Wesenberg F. Low prevalence of femoral venous thrombosis after cardiac catheterizations in children: a prospective study. Cardiol Young 2002; 12:513–8.
  • 16. Keane JF, Lang P, Newburger J, Fyler DC. Iliac vein-inferior caval thrombosis after cardiac catheterization in infancy. PediatrCardiol 1980; 1:257–61.
  • 17. Monagle P1. Anticoagulation in the young. Heart. 2004; 90:808-12.
  • 18. Brotschi B, Hug M, Kretschmar O, Rizzi M, Albisetti M. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart. 2015;101:948-53.
  • 19. Veldman A, Nold MF, Michel-Behnke I. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008; 4:1337–48.
  • 20. Hanslik A, Kitzmüller E, Thom K, et all. Incidence of thrombotic and bleeding complications during cardiac catheterization in children: comparison of high-dose vs. low-dose heparin protocols. J ThrombHaemost. 2011; 9:2353-60.
  • 21. Monagle P, Chalmers E,Chan A, et all. Antithrombotic therapy in children: American College Of Chest Physicians Evidence Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:887S-968S.
  • 22. Hanslik A, Kitzmüller E, Tran US, et all. Monitoring unfractionated heparin in children: a parallel-cohort randomized controlled trial comparing 2 dose protocols. Blood. 2015 29;126:2091-7.
  • 23. Heller C1, Nowak-Göttl U. Maternal thrombophilia and neonatal thrombosis. Best Pract Res ClinHaematol. 2003; 16:333-45.
  • 24. Kosch A, Kuwertz-Broking E, Heller C, et all. Renal venous thrombosis in neonates: prothrombotic risk factors and long-term followup. Blood 2004;104:1356–60
  • 25. Ghasemi A, Horri M, Salahshour Y. Coagulation Abnormalities in Pediatric Patients with Congenital Heart Disease: A Literature Review. International Journal of Pediatrics, 2014; 2:141-3.
  • 26. Tempe DK, Viramani S. Coagulation abnormalities in patients with cyanotic congenital heart disease. J CardiothoracVascAnesth 2002; 16:752-65.
There are 26 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Sara Erol 0000-0002-8758-7662

Banu Aydın This is me 0000-0002-8677-6090

Hasibe Gokce Cinar This is me 0000-0003-2687-1544

Tamer Yoldas This is me 0000-0002-5086-6625

Aysegul Zenciroglu This is me 0000-0002-3488-4962

Publication Date March 3, 2019
Submission Date October 5, 2018
Published in Issue Year 2019 Volume: 46 Issue: 1

Cite

APA Erol, S., Aydın, B., Cinar, H. G., Yoldas, T., et al. (2019). Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates. Dicle Tıp Dergisi, 46(1), 109-118. https://doi.org/10.5798/dicletip.534847
AMA Erol S, Aydın B, Cinar HG, Yoldas T, Zenciroglu A. Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates. diclemedj. March 2019;46(1):109-118. doi:10.5798/dicletip.534847
Chicago Erol, Sara, Banu Aydın, Hasibe Gokce Cinar, Tamer Yoldas, and Aysegul Zenciroglu. “Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates”. Dicle Tıp Dergisi 46, no. 1 (March 2019): 109-18. https://doi.org/10.5798/dicletip.534847.
EndNote Erol S, Aydın B, Cinar HG, Yoldas T, Zenciroglu A (March 1, 2019) Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates. Dicle Tıp Dergisi 46 1 109–118.
IEEE S. Erol, B. Aydın, H. G. Cinar, T. Yoldas, and A. Zenciroglu, “Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates”, diclemedj, vol. 46, no. 1, pp. 109–118, 2019, doi: 10.5798/dicletip.534847.
ISNAD Erol, Sara et al. “Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates”. Dicle Tıp Dergisi 46/1 (March 2019), 109-118. https://doi.org/10.5798/dicletip.534847.
JAMA Erol S, Aydın B, Cinar HG, Yoldas T, Zenciroglu A. Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates. diclemedj. 2019;46:109–118.
MLA Erol, Sara et al. “Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates”. Dicle Tıp Dergisi, vol. 46, no. 1, 2019, pp. 109-18, doi:10.5798/dicletip.534847.
Vancouver Erol S, Aydın B, Cinar HG, Yoldas T, Zenciroglu A. Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates. diclemedj. 2019;46(1):109-18.