caa a22 4500 445825928 CHVBK 20180317145259.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1007/s00246-011-9929-4 doi (NATIONALLICENCE)springer-10.1007/s00246-011-9929-4 Hemostatic Response in Paediatric Patients Undergoing Cardiopulmonary Bypass Surgery [Elektronische Daten] [Vera Ignjatovic, Jenny Than, Robyn Summerhayes, Fiona Newall, Stephen Horton, Andrew Cochrane, Paul Monagle] This prospective, single-center cohort study aimed to evaluate the hemostatic response during and after Cardiopulmonary Bypass (CPB) surgery in a large cohort of children up to 6years of age. Blood samples were drawn at eight time points: post-induction of anesthesia, pre-unfractionated heparin (UFH), post-UFH, post-initiation of bypass, pre-protamine, post-protamine, post-chest-closure, and 6h post-chest-closure. As expected, all measures of the UFH effect increased significantly post-UFH bolus and decreased post-protamine administration. However, thrombin generation remained inhibited compared to baseline values despite the post-UFH reversal by protamine. We also demonstrate that residual UFH effect is not responsible for the ongoing inhibition of thrombin observed post-protamine administration. The significant increase in both free and total tissue factor pathway inhibitor levels during the CPB surgery might contribute to the persistent thrombin generation/endogenous thrombin potential inhibition post-protamine administration. This study makes a significant and novel contribution by investigating the physiological mechanisms behind the degree of thrombin inhibition by UFH and the residual levels of thrombin inhibition that continue despite protamine reversal and provides a new foundation for future interventional studies in the setting of paediatric CPB surgery. Springer Science+Business Media, LLC, 2011 Cardiopulmonary bypass nationallicence Unfractionated heparin nationallicence Hemostasis nationallicence Children nationallicence Thrombin generation nationallicence Ignjatovic Vera Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut Than Jenny Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia aut Summerhayes Robyn Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut Newall Fiona Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut Horton Stephen Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia aut Cochrane Andrew Department of Paediatrics, The University of Melbourne, Melbourne, Australia aut Monagle Paul Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut Pediatric Cardiology Springer-Verlag 32/5(2011-06-01), 621-627 0172-0643 32:5<621 2011 32 246 https://doi.org/10.1007/s00246-011-9929-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00246-011-9929-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ignjatovic Vera Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Than Jenny Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia aut NATIONALLICENCE 700 1- Summerhayes Robyn Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Newall Fiona Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Horton Stephen Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia aut NATIONALLICENCE 700 1- Cochrane Andrew Department of Paediatrics, The University of Melbourne, Melbourne, Australia aut NATIONALLICENCE 700 1- Monagle Paul Haematology Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Melbourne, VIC, Australia aut NATIONALLICENCE 773 0- Pediatric Cardiology Springer-Verlag 32/5(2011-06-01), 621-627 0172-0643 32:5<621 2011 32 246 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer