Decreased plasma ADAMTS-13 activity as a predictor of postoperative bleeding in cyanotic congenital heart disease
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Citações na Scopus
7
Tipo de produção
article
Data de publicação
2013
Título da Revista
ISSN da Revista
Título do Volume
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
Autores
SOARES, Rosangela P. S.
HIRONAKA, Janete Ferreira
Citação
CLINICS, v.68, n.4, p.531-536, 2013
Resumo
OBJECTIVE: To analyze the preoperative plasma antigenic concentration and activity of von Willebrand factor and its main cleaving protease ADAMTS-13 in pediatric patients with cyanotic congenital heart disease undergoing surgical treatment and investigate possible correlations with postoperative bleeding. METHODS: Plasma antigenic concentrations (von Willebrand factor: Ag and ADAMTS-13: Ag) were measured using enzyme-linked immunoassays. Collagen-binding assays were developed to measure biological activities (von Willebrand factor: collagen binding and ADAMTS-13 activity). The multimeric structure of von Willebrand factor was analyzed using Western immunoblotting. Demographic, diagnostic, and general and specific laboratory data and surgery-related variables were subjected to univariate, bivariate, and multivariate analysis for the prediction of postoperative bleeding. RESULTS: Forty-eight patients were enrolled, with ages ranging from 9 months to 7.6 years (median 2.5 years). The plasma concentrations of von Willebrand factor: Ag and ADAMTS-13: Ag were decreased by 65 and 82%, respectively, in the patients compared with the controls (p<0.001). An increased density of low-molecular-weight fractions of von Willebrand factor, which are suggestive of proteolytic degradation (p = 0.0081), was associated with decreased ADAMTS-13 activity, which was likely due to ADAMTS-13 consumption (71% of controls, p = 0.0029) and decreased von Willebrand factor: collagen binding (76% of controls, p = 0.0004). Significant postoperative bleeding occurred in 13 patients. The preoperative ADAMTS-13 activity of <64.6% (mean level for the group), preoperative activated partial thromboplastin time, and the need for cardiopulmonary bypass were characterized as independent risk factors for postoperative bleeding, with respective hazard ratios of 22.35 (95% CI 1.69 to 294.79), 1.096 (95% CI 1.016 to 1.183), and 37.43 (95% CI 1.79 to 782.73). CONCLUSION: Low plasma ADAMTS-13 activity is a risk factor for postoperative bleeding in children with cyanotic congenital heart disease, particularly in children undergoing cardiopulmonary bypass.
Palavras-chave
Congenital Heart Disease, Pediatric Cardiac Surgery, Bleeding Tendency, ADAMTS-13, von Willebrand factor (Cleaving Protease), Hemostasis
Referências
- Bongers TN, 2009, ATHEROSCLEROSIS, V207, P250, DOI 10.1016/j.atherosclerosis.2009.04.013
- Claus RA, 2009, THROMB HAEMOSTASIS, V101, P239, DOI 10.1160/TH08-03-0161
- Crawley JTB, 2008, J THROMB HAEMOST, V6, P583, DOI 10.1111/j.1538-7836.2008.02902.x
- FEDERICI AB, 1992, BLOOD, V79, P38
- FEDERICI AB, 1993, BLOOD, V81, P720
- GOTO S, 1995, J BIOL CHEM, V270, P23352
- Hattori R, 1988, CIRCULATION, V78, pII
- Hyun J, 2009, THROMB RES, V124, P75, DOI 10.1016/j.thromres.2008.11.020
- Levin E, 2000, THROMB HAEMOSTASIS, V83, P54
- Lill MC, 2006, AM J CARDIOL, V98, P254, DOI 10.1016/j.amjcard.2006.01.083
- Lopes AA, 2002, BRAZ J MED BIOL RES, V35, P1259, DOI 10.1590/S0100-879X2002001100002
- Mannucci PM, 2005, J THROMB HAEMOST, V3, P397, DOI 10.1111/j.1538-7836.2005.01115.x
- Molvarec A, 2009, THROMB HAEMOSTASIS, V101, P305, DOI 10.1160/TH08-05-0330
- Panzer S, 2010, THROMB HAEMOSTASIS, V103, P408, DOI 10.1160/TH09-06-0391
- Pareti FI, 2000, CIRCULATION, V102, P1290
- Pinsky DJ, 1996, J CLIN INVEST, V97, P493, DOI 10.1172/JCI118440
- RIBES JA, 1987, J CLIN INVEST, V79, P117, DOI 10.1172/JCI112771
- Rick ME, 2002, THROMB HAEMOSTASIS, V88, P598
- SCHORER AE, 1987, BRIT J HAEMATOL, V67, P193, DOI 10.1111/j.1365-2141.1987.tb02326.x
- Siedlecki CA, 1996, BLOOD, V88, P2939
- Siekmann J, 1998, HAEMOPHILIA, V4, P15
- Tsai HM, 2002, J MOL MED-JMM, V80, P639, DOI 10.1007/s00109-002-0369-8
- Uemura M, 2005, BLOOD, V106, P922, DOI 10.1182/blood-2005-01-0152
- ZAVOICO GB, 1989, J IMMUNOL, V142, P3993
- Zonis Z, 1996, J THORAC CARDIOV SUR, V111, P982, DOI 10.1016/S0022-5223(96)70374-4
Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - LIM/31
Artigos e Materiais de Revistas Científicas - ODS/03
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - LIM/31
Artigos e Materiais de Revistas Científicas - ODS/03