Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 1;23(9):727-735.
doi: 10.1097/PCC.0000000000003011. Epub 2022 Jun 10.

Exploratory Use of Glycoprotein IIb/IIIa Inhibition in Prevention of Blalock-Taussig Shunt Thrombosis

Breanna L Piekarski  1 , Jenna Rogers  1 , David Zurakowski  2 , Ravi Thiagarajan  3 , Sitaram M Emani  1
Affiliations

Exploratory Use of Glycoprotein IIb/IIIa Inhibition in Prevention of Blalock-Taussig Shunt Thrombosis

Breanna L Piekarski et al. Pediatr Crit Care Med. .

Abstract

Objectives: Morbidity and mortality related to modified Blalock-Taussig shunt (mBTTS) thrombosis remain a significant risk. Platelet inhibition following mBTTS may reduce this risk. However, oral antiplatelet agents have variable absorption following surgery. We determine risk factors for mBTTS thrombosis and hypothesize that IV glycoprotein IIb/IIIa inhibitor (tirofiban) as a bridge to oral aspirin reduces the rate of shunt thrombosis in the immediate postoperative period. End points within the 14-day follow-up period include mBTTS thrombosis, overall thrombosis, bleeding, length of stay, and mortality.

Design: Retrospective, Institutional Review Board-approved cohort study.

Setting: Single-center cardiac ICU.

Patients: Patients under the age of 18 who had an mBTTS placed within the study period of January 2008 to December 2018 were included.

Interventions: Patients were divided into two groups: standard of care (SOC) anticoagulation alone and SOC with tirofiban as a bridge to oral aspirin.

Measurements and main results: Freedom from mBTTS thrombosis was estimated using the Kaplan-Meier method. A multivariable predictive model using the four most significant risk factors was developed using logistic regression. A total of 272 patients were included: 36 subjects in the SOC/tirofiban group and 236 in the SOC group. Shunt thrombosis occurred in 26 (11%) SOC group with zero in SOC/tirofiban group ( p = 0.03). The median time to thrombosis was 0 days (range, 0-12 d). The area under the curve for the predictive model (anticoagulation group, history of coagulopathy, intraoperative shunt clipping, and shunt size/weight ratio) is 0.790 ( p < 0.001). Prevalence of bleeding and mortality was not significantly different between the groups.

Conclusions: Highest risk for shunt thrombosis following mBTTS occurs within the first few days after surgical procedure. Tirofiban is a safe addition to SOC and may be an effective strategy to prevent early mBTTS thrombosis.

PubMed Disclaimer

Conflict of interest statement

Drs. Piekarski and Emani disclosed the off-label product use of tirofiban for thrombosis prevention in pediatric patients undergoing modified Blalock-Taussig shunt placement. Dr. Thiagarajan’s institution received funding from Bristol Myers Squibb; he received funding from Advocate Children’s Hospital and Extracorporeal Life Support Organization. Dr. Emani disclosed that he is a consultant for Chiesi Pharmaceuticals. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Küçük M, Özdemir R, Karaçelik M, et al.: Risk factors for thrombosis, overshunting and death in infants after modified Blalock-Taussig shunt. Acta Cardiol Sin 2016; 32:337–342
    1. Sasikumar N, Hermuzi A, Fan CS, et al.: Outcomes of Blalock-Taussig shunts in current era: A single center experience. Congenit Heart Dis 2017; 12:808–814
    1. Chittithavorn V, Duangpakdee P, Rergkliang C, et al.: Risk factors for in-hospital shunt thrombosis and mortality in patients weighing less than 3 kg with functionally univentricular heart undergoing a modified Blalock-Taussig shunt. Interact Cardiovasc Thorac Surg 2017; 25:407–413
    1. Heidari-Bateni G, Norouzi S, Hall M, et al.: Defining the best practice patterns for the neonatal systemic-to-pulmonary artery shunt procedure. J Thorac Cardiovasc Surg 2014; 147:869–873.e3
    1. Saini A, Joshi AD, Cowan KM, et al.: High acetylsalicylic acid dosing in infants after modified Blalock-Taussig shunt. Cardiol Young 2019; 29:389–397

MeSH terms