Use of Low-Molecular-Weight Heparin for Right Atrial Thrombus Following Extracorporeal Membrane Oxygenation in Neonates after Surgical Repair of Congenital Diaphragmatic Hernia: A Case Report and Review of the Literature
DOI:
https://doi.org/10.59958/hsf.7811Keywords:
low molecular weight heparin, congenital diaphragmatic hernia, neonates, extracorporeal membrane oxygenation, right atrial thrombusAbstract
Some critically ill neonates with congenital diaphragmatic hernia (CDH) require extracorporeal membrane oxygenation (ECMO) during the perioperative period. Neonates on ECMO face a significantly increased risk of thrombotic events. Thrombosis management varies across centers and may include anticoagulation, thrombolysis, or thrombectomy. We present our experience using low molecular weight heparin (LMWH) to treat a right atrial thrombus (RAT) following ECMO in a neonate with CDH.
References
Zani A, Chung WK, Deprest J, Harting MT, Jancelewicz T, Kunisaki SM, et al. Congenital diaphragmatic hernia. Nature Reviews. Disease Primers. 2022; 8: 37.
Kays DW. ECMO in CDH: Is there a role? Seminars in Pediatric Surgery. 2017; 26: 166–170.
Dalton HJ, Garcia-Filion P, Holubkov R, Moler FW, Shanley T, Heidemann S, et al. Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatric Critical Care Medicine. 2015; 16: 167–174.
Yang JY, Williams S, Brandão LR, Chan AK. Neonatal and childhood right atrial thrombosis: recognition and a risk-stratified treatment approach. Blood Coagulation & Fibrinolysis: an International Journal in Haemostasis and Thrombosis. 2010; 21: 301–307.
Marsh D, Wilkerson S, Cook L, Pietsch J. Right atrial thrombosis in neonates receiving central venous lines after extracorporeal membrane oxygenation. Critical Care Medicine. 1988; 16: 202–203.
Riccabona M, Kuttnig-Haim M, Dacar D, Urlesberger B, Reiterer F, Maurer U, et al. Venous thrombosis in and after extracorporeal membrane oxygenation: detection and follow-up by color Doppler sonography. European Radiology. 1997; 7: 1383–1386.
Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics. 1995; 96: 939–943.
Veldman A, Nold MF, Michel-Behnke I. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vascular Health and Risk Management. 2008; 4: 1337–1348.
Torres-Valdivieso MJ, Cobas J, Barrio C, Muñoz C, Pascual M, Orbea C, et al. Successful use of tissue plasminogen activator in catheter-related intracardiac thrombus of a premature infant. American Journal of Perinatology. 2003; 20: 91–96.
Williams S, Chan AKC. Neonatal portal vein thrombosis: diagnosis and management. Seminars in Fetal & Neonatal Medicine. 2011; 16: 329–339.
Dix D, Andrew M, Marzinotto V, Charpentier K, Bridge S, Monagle P, et al. The use of low molecular weight heparin in pediatric patients: a prospective cohort study. The Journal of Pediatrics. 2000; 136: 439–445.
Klaassen ILM, Sol JJ, Suijker MH, Fijnvandraat K, van de Wetering MD, Heleen van Ommen C. Are low-molecular-weight heparins safe and effective in children? A systematic review. Blood Reviews. 2019; 33: 33–42.
Perez Ortiz A, Dempfle CE, Jung T, Doniga T, Weiß C, Hetjens S, et al. Assessing Anticoagulation in Neonates With Congenital Diaphragmatic Hernia During Extracorporeal Membrane Oxygenation: Does Anti-Factor Xa or Thromboelastometry Provide Additional Benefit? Frontiers in Pediatrics. 2021; 9: 685906.
Burša F, Sklienka P, Frelich M, Jor O, Ekrtová T, Máca J. Anticoagulation Management during Extracorporeal Membrane Oxygenation-A Mini-Review. Medicina. 2022; 58: 1783.
Ting J, Yeung K, Paes B, Chan AKC, Petropoulos JA, Banfield L, et al. How to use low-molecular-weight heparin to treat neonatal thrombosis in clinical practice. Blood Coagulation & Fibrinolysis. 2021; 32: 531–538.
Published
How to Cite
Issue
Section
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
