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We hypothesized that in CHD patients undergoing cardiac surgery, increased perioperative use of pro-coagulant products may be associated with postoperative thrombosis in the setting of hyperfibrinogenemia, leading to greater hospital and blood product costs. Single-center retrospective study. Data from Boston Children\u2019s Hospital\u2019s electronic health record database was used in this study. All patients undergoing congenital heart surgery between 2015 and 2018 with postoperative fibrinogen levels above 400\u00a0mg\/dl were reviewed. Of 334 patients with high plasma fibrinogen levels, 28 (8.4%) developed postoperative thrombosis (median age: one year, 59% male). In our cohort, 25 (7%) demonstrated evidence of baseline hypercoagulability by one or more panel test results. Thrombosis was associated with greater hospital and blood product costs, longer ventilation times, and longer hospital and ICU length of stays. Preoperative hypercoagulable state (odds ratio: 2.58, 95% CI [1.07, 9.99], p\u2009=\u20090.002), postoperative red blood cell transfusion (odds ratio: 1.007, 95% CI [1.000, 1.015], p\u2009=\u20090.04), and single ventricle physiology (univariate odds ratio: 2.94, 95% CI [1.09, 7.89], p\u2009=\u20090.03) were predictors of postoperative thrombosis. Preoperative hypercoagulable state and intraoperative platelet transfusion were predictors of hospital cost. Thrombosis was associated with worse in-hospital outcomes and higher costs. Preoperative hypercoagulable state and postoperative red blood cell transfusion were significant predictors of thrombosis. Risk prediction models that can guide thrombosis prevention are needed to improve outcomes of patients undergoing congenital heart surgery.<\/jats:p>","DOI":"10.1007\/s00246-024-03554-1","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T19:01:40Z","timestamp":1718910100000},"page":"1328-1339","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Perioperative Hyper-coagulation and Thrombosis: Cost Analysis After Congenital Heart Surgery"],"prefix":"10.1007","volume":"46","author":[{"given":"Puja","family":"Dutta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meena","family":"Nathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitaram M.","family":"Emani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirisha","family":"Emani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Ibla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"issue":"14","key":"3554_CR1","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1161\/CIRCULATIONAHA.110.006304","volume":"124","author":"C Manlhiot","year":"2011","unstructured":"Manlhiot C, Menjak IB, Brand\u00e3o LR et al (2011) Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery. 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