YENİDOĞANLARDA ROTASYONEL TROMBOELASTOGRAFİ İLE UMBİLİKAL VENÖZ KATETER İLİŞKİLİ TROMBOZ GELİŞİM RİSKİNİN DEĞERLENDİRİLMESİ

Öz

Amaç: Yenidoğan döneminde tromboz gelişimi riski yüksektir ve en sık nedeni ise kateter ilişkili trombozlardır. Hangi bebeklerin daha riskli olduğunu önceden tespit etmeyi sağlayan bir yöntem henüz mevcut değildir. Çalışmanın amacı, umbilikal venöz kateter takılan yenidoğanlarda, rotasyonel tromboelastografi kullanarak kateter ilişkili tromboz gelişme riskinin öngörülebilirliğini araştırmaktır. Gereç ve Yöntemler: Yenidoğan yoğun bakım ünitesinde izlenen, umbilikal venöz kateter takılan ve umbilikal kateterin bir haftadan uzun kalacağı öngörülen hastalar çalışmaya dahil edilmiştir. Kateter takılmadan önce hastalardan kan örneği alınarak rotasyonel tromboelastografi ile analizler yapılmıştır. Hastalar, bu sonuçlardan haberi olmayan bir radyolog tarafından kateter çıkarıldıktan sonra tromboz açısından Doppler ultrasonografi (USG) ile değerlendirimiştir. Bulgular: Çalışmaya dahil edilen hastaların ortalama gebelik yaşı 36.5±1.73 hafta, doğum ağırlığı ortanca değeri 3005 (IQR 1335) gramdır. Ekstrinsik rotasyonel tromboelastografi (EXTEM) ölçümlerinde; ortalama koagülasyon zamanı (CT) 160±92 sn, ortalama maksimal pıhtı sağlamlığı (MCF) 5±1.15 mm, fibrinojen rotasyonel tromboelastografi (FIBTEM) ölçümlerinde ortalama MCF 5±1.15 mm saptanmıştır. Kateter çıkarıldıktan sonra hastaların hiçbirinde umbilikal vende tromboz saptanmamıştır. Sonuç: Daha önceki veriler ışığında EXTEM’de CT’nin <40 sn, EXTEM’deki MCF’nin >68 mm ve FIBTEM’deki MCF’nin >24 mm olmasının tromboz riskini gösterdiği bilinmektedir. Çalışmada tromboz saptanmaması; bu belirteçlerin riski doğru öngörebildiğini desteklemektedir.

Anahtar Kelimeler

• Yenidoğan
• tromboelastografi
• venöz tromboz

Evaluation of Umbilical Venous Catheter-Related Thrombosis Risk by Rotational Thromboelastography in Newborns

Öz

Objective: Development of thrombosis in the neonatal period is high and one of the most common causes is catheter-related thrombosis. There is not yet a method that allows to detect which babies are more risky beforehand. The aim of the study is to investigate the predictability of the risk of developing catheter-related thrombosis using rotational thromboelastography in neonates with umbilical venous catheters. Material and Methods: Patients who were followed up in the neonatal intensive care unit, had an umbilical venous catheter and were predicted to stay longer than one week were included in the study. Before the catheter was inserted, blood samples were taken from the patients and analyzed by rotational thromboelastography. After catheter removal, patients were evaluated by Doppler ultrasonography (USG) for thrombosis by a radiologist who was unaware of these results. Results: The mean gestational age of the patients included in the study was 36.5±1.73 weeks, and the median birth weight was 3.005 (IQR 1335) grams. In the measurements made for extrinsic rotational thromboelastometry (EXTEM); the mean coagulation time (CT) was 160±92 sec, the mean maximum clot firmness (MCF) was 5±1.15 mm, in measurements made for fibrinogen rotational thromboelastometry (FIBTEM); The mean MCF was 5±1.15 mm. No umbilical vein thrombosis was detected in any of the patients after the catheter was removed. Conclusion: In the light of previous data, it is known that CT<40 sec in EXTEM, MCF >68mm in EXTEM, and MCF >24mm in FIBTEM indicate the risk of thrombosis. No thrombosis was detected in the study; supports that these markers can accurately predict risk.

Anahtar Kelimeler

• Newborn
• thromboelastography
• venous thrombosis

Kaynakça

1. Letterio J, Pateva I, Petrosiute A, Ahuja S. Hematologic and oncologic problems in the fetus and neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff & Martin’s Neoanatal-Perinatal Medicine Diseases of the Fetus and Infant. 11th ed. Philadelphia. Elsevier, 2020:1416-72.
2. Schmidt B, Andrew M. Neonatal thrombosis: Report of a prospective Canadian and international registry. Pediatrics. 1995;96(5 Pt 1):939-43.
3. Haley KM. Neonatal venous thromboembolism. Front Pediatr. 2017;5:136.
4. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-8.
5. Schwartz DS, Gettner PA, Konstantino MM, Bartley CL, Keller MS, Ehrenkranz RA, et al. Umblical venous catheterization and the risk of portal thrombosis. J Pediatr. 1997;131(5):760-2.
6. Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umblical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology. 2001;219(3):645-50.
7. Tarango C, Schulman S, Betensky M, Goldenberg NA. Duration of anticoagulant therapy in pediatric venous thromboembolism: Current approaches and updates from randomized controlled trials. Expert Rev Hematol. 2018;11(1):37-44.
8. Will A. Neonatal haemostasis and the management of neonatal thrombosis. Br J Haematol. 2015;169(3):324-32.

9. Nowak-Göttl U, von Kries R, Göbel U. Neonatal symptomatic thromboembolism in Germany: Two year survey. Arch Dis Child Fetal Neonatal Ed. 1997;76(3):F163-7.
10. Gharehbaghi MM, Nemati M, Hosseinpour SS, Taei R, Ghargharechi R. Umblical vascular catheter associated portal vein thrombosis detected by ultrasound. Indian J Pediatr. 2011;78(2):161-4.
11. Akman İ, Dalkan C. Yenidoğan döneminde tromboz. Gazi Med J. 2012;23:19-24.
12. Theodoraki M, Sokou R, Valsami S, Iliodromiti Z, Pouliakis A, Parastatidou S, et al. Reference values of thrombolastometry parameters in healthy term neonates. Children (Basel). 2020;7(12):259.
13. Fahrendorff M, Oliveri RS, Johansson PI. The use of viscoelastic haemostatic assays in goal directing treatment with allogeneic blood products - A systematic review and meta analysis. Scand J Trauma Resusc Emerg Med. 2017;25(1):39.
14. Dias JD, Haney EI, Mathew BA, Lopez-Espina CG, Orr AW, Popovsky MA. New-generation thromboelastography: Comprehensive evaluation of citrated and heparinized blood sample storage effect on clot-forming variables. Arch Pathol Lab Med.2017;141(4):569-77.
15. Hincker A, Feit J, Sladen RN, Wagener G. Rotational thromboelastometry predicts thromboemboli complications after major non- cardiac surgery. Crit Care. 2014:18(5);549.
16. Kolbenschlag J, Daigeler A, Lauer S, Wittenberg G, Fischer S, Kapalschinski N et al. Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery? Microsurgery. 2014;34(4):253-60.
17. Parastatidou S, Sokou R, Tsantes AG, Konstantinidi A, Lampridou M, Ioakeimidis G, et al. The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates. Eur J Haematol. 2021;106(2):175-83.
18. Katsaras GN, Sokou R, Tsantes AG, Konstantinidi A, Gialamprinou D, Piovani D, et al. Thromboelastometry in neonates with respiratory distress syndrome: A pilot study. Diagnostics (Basel). 2021;11(11):1995.
19. Konstantinidi A, Sokou R, Tsantes AG, Parastatidou S, Bonovas S, Kouskouni et al. Thromboelastometry variables in neonates with perinatal hypoxia. Semin Thromb Hemost. 2020;46(4):428-34.
20. Sokou R, Tsantes AG, Konstantinidi A, Ioakeimidis G, Lampridou M, Parastatidou S, et al. Rotational thromboelastometry in neonates admitted to a neonatal intensive care unit: A large cross-sectional study. Semin Thromb Hemost. 2021;47(7):875-84.
21. Görlinger K, Dirkmann D, Hanke AA. Rotational thromboelastomestry (ROTEM). Trauma induced coagulopathy. In: Gonzalez E, Moore HB, Moore EE, eds. Trauma Induced Coagulapathy. 1st ed. Switzerland. Springer International Publishing, 2016:267-98.
22. Strauss T, Levy-Shraga Y, Ravid B, Schushan-Eisen I, Maayan-Metzger A, Kuint J, et al. Clot formation of neonates tested by thromboelastography correlates with gestational age. Thromb Haemost. 2010;103(2):344-50.
23. Dimitrova-Karamfi lA, Patokova Y, Solarova T,Petrova I, Natchev G. Rotation thromboelastography for assessment of hypercoagulation and thrombosis in patients with cardiovascular diseases. J Life Sci. 2012;6:28-35.
24. Ignjatovic V, Ilhan A, Monagle P. Evidence for age- related differences in human fibrinogen. Blood Coagul Fibrinolysis. 2011;22(2):110-7