Resumen
complicaciones cardíacas es cada vez mayor. El control de la anticoagulación en pediatría es uno de los aspectos más complicados en los pacientes post-cirugía cardiaca.
Esta investigación tuvo como objetivo determinar si un protocolo de monitorización de la anticoagulación en pacientes pediátricos post-cirugía cardíaca tratados con ECMO venoarterial (VA) resulta en menos complicaciones hemorrágicas y prolonga la supervivencia. Se trata de un estudio retrospectivo, observacional, descriptivo, de un solo brazo, realizado en el Hospital Christus Muguerza de Monterrey, México. Las variables fueron el tiempo de coagulación activado (ACT), el tiempo de tromboplastina parcial activada (TTPa), la actividad anti-Factor Xa (anti-Xa) y los parámetros antitrombina III (AT). Los resultados de las pruebas se correlacionaron con la tasa de infusión de heparina no fraccionada (HNF) (UI/kg/h) en el momento de la toma de muestras.
La dosis media de heparina fue de 21.09 UI/kg/h. La ACT fue de 188.6 segundos y la anticoagulación terapéutica basada en ACT de 180 a 220 segundos. El TTPa obtenido en este estudio fue de 62.15 segundos. El nivel de anti-Xa fue de 0.27 UL/mL y el de AT de 47.52 UI. Obtuvimos una tasa de supervivencia del 60%. Las principales complicaciones hemorrágicas fueron sangrado grave al 10% y trombosis sistémica al 10%. Las principales complicaciones fueron sepsis, insuficiencia renal y hemorragia grave.
Se necesitan más ensayos prospectivos para delinear el cambio de dosis con la HNF y prevenir resultados clínicos adversos en diferentes afecciones de cirugía cardíaca pediátrica.
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