Arterial thromboembolism, antithrombotic therapy, and risk of recurrent thromboembolism in children with CHD undergoing cardiac surgery

Authors

Amy L. Kiskaddon, Divisions of Cardiology and Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nhue L. Do, Advocate Health - MidwestFollow
Ernest K. Amankwah, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA.
Daniel M. Witt, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Vera Ignjatovic, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA.
Therese M. Giglia, Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Gary M. Woods, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Hilary B. Whitworth, Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Arabela C. Stock, Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Neil A. Goldenberg, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA.

Recommended Citation

Kiskaddon AL, Do NL, Amankwah EK, et al. Arterial thromboembolism, antithrombotic therapy, and risk of recurrent thromboembolism in children with CHD undergoing cardiac surgery. Cardiol Young. 2025;35(4):679-682. doi:10.1017/S1047951125001271

Affiliations

Advocate Children's Hospital

Abstract

Introduction: Data on arterial thromboembolism in children undergoing cardiac surgery are limited. We sought to characterise, and estimate rates of, incident and recurrent arterial thromboembolism, and describe antithrombotic therapies for treatment in a large multinational population of children with CHD undergoing cardiac surgery.

Methods: We queried the TriNetX global electronic health record (derived real-world data research platform) from 2017 to 2024 for patients less than 18 years of age and an index arterial thromboembolism within 1 year of congenital cardiac surgery. Data were descriptively analysed.

Results: Of 20,102 children who underwent an index cardiac surgery for CHD, 206 (1.1%) developed an index arterial thromboembolism within 1 year of surgery: 111 (53.9%) had only arterial thromboembolism and 95 (46.1%) had concomitant venous thromboembolism. The most common anatomic site for arterial thromboembolism was the lower extremity ( n = 141, 68.4%), and the most common surgery was the Glenn procedure ( n = 35, 17%). Unfractionated heparin was utilised in 136 (67 %) and aspirin in 91 (44.2%) patients. Recurrent thromboembolism occurred in 36 (17.5%) patients within 1 year of the index thromboembolism.

Conclusions: Among children undergoing congenital cardiac surgery, arterial thromboembolism was rare (1% of patients), but the 1-year risk of recurrent thromboembolism was high, at 17.5%. Multicentre prospective cohort studies are warranted to further evaluate risk factors for recurrent thromboembolism, to facilitate future risk-stratified interventional trials designed to reduce the high thromboembolism recurrence risk in these children.

Document Type

Article

PubMed ID

40012325