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Thromb Haemost 2000; 83(05): 678-682
DOI: 10.1055/s-0037-1613891
Review Article
Schattauer GmbH

Hemostatic Changes following the Modified Fontan Operation (Total Cavopulmonary Connection)

Ralf Rauch
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
,
Martin Ries
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
,
Michael Hofbeck
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
,
Gernot Buheitel
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
,
Helmut Singer
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
,
Jens Klinge
1   From the Children‘s Hospital of the Friedrich-Alexander-Universität, Erlangen-Nuernberg, Germany
› Author Affiliations
Further Information

Publication History

Received 31 October 1998

Accepted after resubmission 07 December 1999

Publication Date:
08 December 2017 (online)

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Summary

Thromboembolism is a serious complication after Fontan operation, which may be caused by alterations of the coagulation system. We therefore investigated pro- and anticoagulant factors in 20 patients aged 4 to 21 years, 4 to 63 months following total cavopulmonary connection. Furthermore we compared markers of thrombin activation and fibrinolysis and in vitro clotting and clot-lysis to age-matched healthy subjects.

Compared to results of age-matched controls, the Fontan operated individuals had significant decreases in levels of protein C (0.88 U/ml in controls, 0.67 U/ml in patients; p <0.001) and protein S (1.05 in controls, 0.93 U/ml in patients; p <0.05). Moreover, half of the patients had high values of FVIII (>1.5 IU/ml), which are associated with an increased thrombotic risk. These changes may result in enhanced generation of thrombin and plasmin, indicated by our finding of increased thrombin-antithrombin III (TAT) and plasmin-antiplasmin (PAP) levels and a similar trend in prothrombin fragments F1+2. Clot lysis tests, global coagulation tests, red blood cell count, liver enzymes AST, ALT, but not GGT, were generally within the normal ranges.

Keywords

Fontan-operation - TCPC - thrombosis - coagulation cascade - D-dimer - TAT - PAP - F1+2
 

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