Journal of cardiothoracic and vascular anesthesia · 2026
Thrombotic Outcomes Associated With Factor Eight Inhibitor Bypassing Activity Use in Neonatal and Infant Cardiac Surgery Including the Norwood Procedure: A Propensity Score‒Matched Analysis.
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Houska Nicholas, McCaw Nicole, Meneses Emily C, Ing Richard J, Whitney Gina, Fraser Charles, Warren Beth B, Navaratnam Manchula, Kim John S
Аннотация
OBJECTIVES: To describe thrombotic outcomes associated with Factor Eight Inhibitor Bypassing Activity (FEIBA) exposure in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass (CPB), including the Norwood procedure.
DESIGN: Single-center, retrospective, propensity score-matched cohort study.
SETTING: Tertiary pediatric cardiac surgery center.
PARTICIPANTS: Neonates and infants (<1 year) undergoing cardiac surgery with CPB.
INTERVENTIONS: FEIBA administered as rescue therapy for refractory bleeding following CPB.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was postoperative thrombosis at 7 and 30 days. After propensity score matching, 198 patients were analyzed across 4 cohorts (Norwood neonates, non-Norwood neonates, combined neonates, and infants). FEIBA exposure was not associated with a statistically significant increase in the odds of thrombosis at 7 or 30 days in any cohort. Among Norwood neonates, thrombosis rates were higher with FEIBA exposure (17.4% v 8.7% at 7 days; 26.1% v 13.0% at 30 days) but were not statistically significant (odds ratio [OR] 2.18, 95% confidence interval [CI] 0.37-17.28; p = 0.405 at 7 days and OR 2.22, 95% CI 0.48-12.13; p = 0.319 at 30 days). The odds of shunt intervention before stage II palliation were lower among FEIBA-exposed Norwood neonates (OR 0.20, 95% CI 0.04-0.88; p = 0.047).
CONCLUSION: This study found that FEIBA use was not associated with a statistically significant increase in postoperative thrombosis in neonates and infants after cardiac surgery. Though patients undergoing the Norwood procedure had a 2-fold (nonsignificant) increase in catheter-associated thrombosis, we found no increase in the rate of shunt thrombosis or intervention.
DESIGN: Single-center, retrospective, propensity score-matched cohort study.
SETTING: Tertiary pediatric cardiac surgery center.
PARTICIPANTS: Neonates and infants (<1 year) undergoing cardiac surgery with CPB.
INTERVENTIONS: FEIBA administered as rescue therapy for refractory bleeding following CPB.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was postoperative thrombosis at 7 and 30 days. After propensity score matching, 198 patients were analyzed across 4 cohorts (Norwood neonates, non-Norwood neonates, combined neonates, and infants). FEIBA exposure was not associated with a statistically significant increase in the odds of thrombosis at 7 or 30 days in any cohort. Among Norwood neonates, thrombosis rates were higher with FEIBA exposure (17.4% v 8.7% at 7 days; 26.1% v 13.0% at 30 days) but were not statistically significant (odds ratio [OR] 2.18, 95% confidence interval [CI] 0.37-17.28; p = 0.405 at 7 days and OR 2.22, 95% CI 0.48-12.13; p = 0.319 at 30 days). The odds of shunt intervention before stage II palliation were lower among FEIBA-exposed Norwood neonates (OR 0.20, 95% CI 0.04-0.88; p = 0.047).
CONCLUSION: This study found that FEIBA use was not associated with a statistically significant increase in postoperative thrombosis in neonates and infants after cardiac surgery. Though patients undergoing the Norwood procedure had a 2-fold (nonsignificant) increase in catheter-associated thrombosis, we found no increase in the rate of shunt thrombosis or intervention.