新生儿和婴儿心脏分流的抗血栓策略和结果：系统回顾和荟萃分析

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-08-01 DOI:10.1016/j.rpth.2025.103161

Amy L. Kiskaddon , Neil A. Goldenberg , Marisol Betensky , Joshua W. Branstetter , Dina Ashour , Pamela Williams , Arabela C. Stock , Michael Silvey , Therese M. Giglia , Nhue L. Do

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引用次数: 0

摘要

背景：新生儿和婴儿的心脏分流血栓形成仍然是引起分流失败和死亡的一个问题。血栓预防的最佳策略仍然未知。目的：本系统综述旨在描述新生儿和婴儿心脏分流术的抗血栓策略和结果。方法检索medline、Embase和Cochrane CENTRAL从成立到2024年7月报道接受心脏分流术的婴儿中分流血栓患病率的研究。我们使用随机效应荟萃分析估计分流血栓的总患病率。在亚组分析中，我们评估了分流类型和抗血栓策略对分流血栓患病率的影响。结果共纳入39项研究，其中回顾性研究29项，前瞻性研究10项，共计4735例患者。最常见的分流类型是改良的Blalock-Taussig （n = 2224, 47%）。102例（26.2%）分流血栓患者与分流血栓相关的死亡率。急性术后最常见的抗血栓药物是未分离肝素（UFH; n = 1452, 30.7%）和阿司匹林（n = 1413, 29.3%）。分流血栓形成的总发生率为8.4% (95% CI, 6.5%-10.4%)，抗栓药物不同：阿司匹林7.4% (95% CI, 4.0%-11.4%), UFH 3.8% (95% CI, 0%-12.3%)， UFH后阿司匹林6.3% （95% CI, 3.6%-9.4%）。结论对近5000名新生儿和婴儿进行了系统回顾，揭示了分流血栓形成的高死亡率。有必要进行前瞻性合作研究，以评估这些儿童的分流血栓和出血结局的抗血栓治疗方案-结果关系和预后因素。

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Antithrombotic strategies and outcomes in neonates and infants with cardiac shunts: a systematic review and meta-analysis

Background

Cardiac shunt thrombosis in neonates and infants remains a concern for shunt failure and mortality. The optimal strategy for thromboprophylaxis remains unknown.

Objectives

This systematic review aims to characterize antithrombotic strategies and outcomes in neonates and infants with a cardiac shunt.

Methods

MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through July 2024 for studies reporting shunt thrombosis prevalence among infants who received a cardiac shunt. We estimated the pooled prevalence of shunt thrombosis using random-effects meta-analysis. In the subgroup analysis, we evaluated the effects of shunt type and antithrombotic strategies on shunt thrombosis prevalence.

Results

A total of 39 studies (29 retrospective, 10 prospective) were included, totaling 4735 patients. The most common shunt type was the modified Blalock-Taussig (n = 2224, 47%). Mortality related to shunt thrombosis occurred in 102 (26.2%) patients with shunt thrombosis. The most common antithrombotic agents in the acute postoperative setting were unfractionated heparin (UFH; n = 1452, 30.7%) and aspirin (n = 1413, 29.3%). The pooled prevalence of shunt thrombosis was 8.4% (95% CI, 6.5%-10.4%) and varied among antithrombotic agents: aspirin 7.4% (95% CI, 4.0%-11.4%), UFH 3.8% (95% CI, 0%-12.3%), or UFH followed by aspirin 6.3% (95% CI, 3.6%-9.4%).

Conclusions

This systematic review of nearly 5000 neonates and infants reveals a high rate of mortality associated with shunt thrombosis. Collaborative prospective studies are warranted to evaluate antithrombotic regimen–outcome relationships and prognostic factors for shunt thrombosis and bleeding outcomes in these children.

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