{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T10:16:25Z","timestamp":1756635385929,"version":"3.41.2"},"reference-count":81,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation algorithm in pediatric cardiac surgery.<\/jats:p><jats:p>This single-center, retrospective data analysis included patients younger than 18 years who underwent cardiac surgery with cardiopulmonary bypass (CPB) and received a coagulation therapy according to a predefined POC-controlled coagulation algorithm. Patients were divided into two groups (&lt;10 and &gt;10\u2009kg body weight) because of different CPB priming strategies.<\/jats:p><jats:p>In total, 173 surgeries with the use of the POC-guided hemostatic therapy were analyzed. In 71% of cases, target parameters were achieved and only in one case primary sternal closure was not possible. Children with a body weight \u226410\u2009kg underwent surgical re-evaluation in 13.2% (15\/113), and respectively 6.7% (4\/60) in patients &gt;10\u2009kg. Hemorrhage in children \u226410\u2009kg was associated with cyanotic heart defects, deeper intraoperative hypothermia, longer duration of CPB, more complex procedures (RACHS-1 score), and with more intraoperative platelets, and respectively red blood cell concentrate transfusions (all p-values\u2009&lt;\u20090.05). In children \u226410\u2009kg, fibrinogen levels were significantly lower over the 12-hour postoperative period (without revision: 3.1 [2.9\u20133.3] vs. with revision 2.8 [2.3\u20133.4]). Hemorrhage in children &gt;10\u2009kg was associated with a longer duration of CPB (p\u2009=\u20090.042), lower preoperative platelets (p\u2009=\u20090.026), and over the 12-hour postoperative period lower platelets (p\u2009=\u20090.002) and fibrinogen (p\u2009=\u20090.05).<\/jats:p><jats:p>The use of a preventive, algorithm-based coagulation therapy with factor concentrates after CPB followed by POC created intraoperative clinical stable coagulation status with a subsequent executable thorax closure, although the presented algorithm in its current form is not superior in the reduction of the re-exploration rate compared to equivalent collectives. Reduced fibrinogen concentrations 12\u2009hours after surgery may be associated with an increased incidence of surgical revisions.<\/jats:p>","DOI":"10.1055\/s-0044-1788931","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T19:11:01Z","timestamp":1723576261000},"page":"387-400","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of Point-of-Care-Directed Coagulation Management in Pediatric Cardiac Surgery"],"prefix":"10.1055","volume":"73","author":[{"given":"Thomas","family":"Zajonz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Edinger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uygar","family":"Yoerueker","sequence":"additional","affiliation":[{"name":"Department of Childrens Heart Center and Cardiovascular Surgery, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hakan","family":"Akint\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Childrens Heart Center and Cardiovascular Surgery, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Markmann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universit\u00e4t Giessen Fachbereich Medizin, Giessen, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1213\/ANE.0000000000000531","article-title":"Excessive postoperative bleeding and outcomes in neonates undergoing cardiopulmonary bypass","volume":"120","author":"N A 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