SARA EROL, BANU AYDIN, Hasibe Gökçe ÇINAR, Tamer YOLDAŞ, AYŞEGÜL ZENCİROĞLU

Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates

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.

Yenidoğanlarda Kardiyak Kateterizasyona İkincil ArteriyelTromboz

Amaç: Kardiyak kateterizasyon, kardiyovasküler hastalıkların tanı ve tedavisinde kullanılan temel işlemlerden biridir. Tromboz gelişimi, kateterizasyonun ciddi bir komplikasyonudur. Bu çalışmada, tanısal ya da girişimsel amaçlı kardiyak kateterizasyon işlemi yapılan yenidoğanlarda arteriyel tromboz gelişimi sıklığı ve tromboz gelişimine etki eden faktörler ileriye dönük olarak incelendi. Yöntemler: 6 aylık süreçte femoral arter kateterizasyonu yapılan 20 yenidoğan çalışmaya alındı. İşlem öncesinde tam kan sayımı, prothrombin ve aktive parsiyel tromboplastin zamanları, INR oranı, Faktör V Leiden, protrombin 20210 A, metilentetrahidrofolat redüktaz C667T ve A1298 mutasyonları için kan örnekleri alındı. İşlem sırasında 100 U/ kg dozunda bolus heparin infüzyonu yapıldı. Kateterizasyon sonrasında klinik olarak tromboz şüphesi bulunan hastalara 28 U/kg/saat dozunda heparin infüzyonu başlandı. Tüm hastalara kateterizasyon sonrası 6 saat içinde Doopler ultrasonografi yapıldı. Sonuçlar: Hastaların gestasyonel yaşları 31-40 hafta (ortanca 39 hafta) aralığındaydı. Ortalama doğum ağırlığı 2996 ± 589 gramdı (1880-4000 gr). Doopler ultrasonografi ile 10 hastada arteriyel tromboz saptandı. Arteriyel tromboz gelişimi üzerine hasta yaşının, cinsiyetinin, tanı ve tedavilerin, platelet sayısının, hemoglobin, protrombin ve aktive parsiyel tromboplastin zamanı değerlerinin, Faktör V Leiden, protrombin 20210 A, metilentetrahidrofolat redüktaz C667T ve A1298 mutasyonlarının etkili olmadığı görüldü (p>0.05). Tromboz saptanan hastaların INR değerleri diğerlerinden daha düşük bulundu (p= 0.023). Sonuç: Bu çalışmada kateterizasyon sonrası femoral arter tromboz sıklığı Doppler ultrasonografiyle %50 olarak belirlendi. Bizim çalışmamız tromboz tanısında erken klinik değerlendirmenin yanıltıcı olabileceğini fakat Doppler ultrasonografinin erken tanıda yardımcı olabileceğini öngörmektedir. Yenidoğanda arteryel kateterizasyon sonrası trombozun önlenmesi için uygun ilaçların ve / veya dozların tahmin edilmesi için ileri çalışmalara ihtiyaç vardır.

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