A Multisite Retrospective Review of Direct Oral Anticoagulants Compared to Warfarin in Adult Fontan Patients

Kazerouninia, Amir; Georgekutty, Justin; Kendsersky, Payton; Byrne, Ryan; Seto, Brendan; Chu, Peng-Cheng; Wang, Yunfei; Rodriguez, Fred H.; Smith, Clayton A.; Saraf, Anita; Lloyd, Michael S.; Frischhertz, Benjamin P.; Parekh, Dhaval R.; Ermis, Peter; Franklin, Wayne; Lam, Wilson

doi:10.1007/s10557-021-07298-5

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…The 2014 PACE/HRS consensus document gave non-vitamin K antagonist oral anticoagulants (NOAC) a class III recommendation to prevent thromboembolism, and vitamin K antagonists (VKAs) were preferred [44]. However, there is no evidence that VKAs are superior to NOACs, and newer evidence has emerged showing excellent safety and efficacy with NOACs in this population [45]. In a retrospective cohort study, the annual risk of bleeding was 3.1% per patient per year, with 0.7% per patient per year thromboembolic events [46].…”

Section: Anticoagulationmentioning

confidence: 99%

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Knijnik

Lloyd

2022

Kardiol Pol

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There are now more adults living with a history of congenital heart disease than there are children. Modern electrophysiologists must familiarize themselves with the most common congenital lesions requiring electrophysiologic care as adults. Advancements in this field have been made most notably with high-resolution 3D imaging and electroanatomic mapping, left ventricular cannulation techniques, alternative pacing strategies, intracardiac echo, and transeptal access tools.

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Section: Anticoagulationmentioning

confidence: 99%

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Knijnik

Lloyd

2022

Kardiol Pol

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“…Direct oral anticoagulants (DOACs), which include the direct thrombin inhibitor dabigatran and factor Xa inhibitors (Apixaban, Rivaroxaban, Edoxaban), have recently become the anticoagulants of choice in adults with acquired non-valvar cardiac disease, such as atrial fibrillation [4], left ventricular thrombus after myocardial infarction and adults with congenital heart disease [5][6][7]. In pediatrics, DOACs are increasingly being considered given the upside of less frequent monitoring and oral administration [8], in addition to their independence of antithrombin III and linear dose response [9].…”

Section: Introductionmentioning

confidence: 99%

Use of Apixaban in Children Awaiting Heart Transplantation

Benvenuto

Hartje-Dunn

et al. 2023

Preprint

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Objective The use of apixaban in the pediatric cardiac population is expanding. We describe our apixaban dosing and monitoring strategy in children and young adults awaiting heart transplantation, along with outcomes related to bleeding and thrombosis during wait-list and early post-transplant periods. Methods This study is a retrospective, single center analysis of all patients receiving apixaban while awaiting cardiac transplantation. Weight-based dosing was monitored with peak drug-specific anti-Xa chromogenic analysis. Significant post-operative bleeding defined by chest tube output or need for surgical intervention. Results From September 2020 through December 2022, 19 patients, median age 13.5 years (6.1, 15.8 years), weighing 48.9 kg (15.4, 67.6) received apixaban while awaiting transplant. Indication for apixaban was prophylaxis (n=18, 3 with ventricular assist devices) and treatment of thrombus (n=1). There were no clinically relevant non-major or major bleeding, nor thrombotic events while awaiting transplant. The median time from last apixaban dose to arrival in the operating room was 23.2 hours (15.6-33.8), with median random apixaban level of 37 ng/ml (28.3, 59), 6.3 hours (4.8, 8.4) prior to arrival in the operating room. 32% of patients had significant post-operative bleeding based on chest tube output post-transplant or need for intervention. No patients meeting criteria for significant postoperative bleeding were thought to be attributable to apixaban. Conclusion Careful use of apixaban can be safe and effective while awaiting heart transplant. There was no appreciable increase in perioperative bleeding. The use of apixaban is promising in providing safe, predictable and efficacious anticoagulation while avoiding additional patient stressors.

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“…Direct oral anticoagulants (DOACs), which include the direct thrombin inhibitor dabigatran and factor Xa inhibitors (Apixaban, Rivaroxaban, Edoxaban), have recently become the anticoagulants of choice in adults with acquired non-valvular cardiac disease, such as atrial fibrillation, 4 left ventricular thrombus after myocardial infarction and adults with congenital heart disease. [5][6][7] In pediatrics, DOACs are increasingly being considered given the upside of less frequent monitoring and oral administration, 8 in addition to their independence of antithrombin III and linear dose response. 9 Apixaban, a direct, reversible inhibitor of factor Xa, is of particular interest in ongoing pediatric trials.…”

mentioning

confidence: 99%

Use of apixaban in children awaiting heart transplantation

Benvenuto,

Hartje‐Dunn,

et al. 2023

Pediatric Transplantation

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BackgroundThe use of apixaban in the pediatric cardiac population is expanding. We describe our apixaban dosing and monitoring strategy in children and young adults awaiting heart transplantation, along with outcomes related to bleeding and thrombosis during wait‐list and early post‐transplant periods.MethodsThis study is a retrospective, single‐center analysis of all patients receiving apixaban while awaiting cardiac transplantation. Weight‐based dosing was monitored with peak drug‐specific anti‐Xa chromogenic analysis. Significant post‐operative bleeding defined by chest tube output or need for surgical intervention.ResultsFrom September 2020 to December 2022, 19 patients, median age 13.5 years (6.1, 15.8 years), weighing 48.9 kg (15.4, 67.6) received apixaban while awaiting transplant. Indication for apixaban was prophylaxis (n = 18, 3 with ventricular assist devices) and treatment of thrombus (n = 1). There were no clinically relevant non‐major or major bleeding, nor thrombotic events while awaiting transplant. The median time from last apixaban dose to arrival in the operating room was 23.2 h (15.6–33.8), with median random apixaban level of 37 ng/mL (28.3, 59), 6.3 h (4.8, 8.4) prior to arrival in the operating room. In this study, 32% of patients had significant post‐operative bleeding based on chest tube output post‐transplant or need for intervention. No patients meeting criteria for significant post‐operative bleeding were thought to be attributable to apixaban.ConclusionsCareful use of apixaban can be safe and effective while awaiting heart transplant. There was no appreciable increase in peri‐operative bleeding. The use of apixaban is promising in providing safe, predictable and efficacious anticoagulation while avoiding additional patient stressors.

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A Multisite Retrospective Review of Direct Oral Anticoagulants Compared to Warfarin in Adult Fontan Patients

Cited by 6 publications

References 34 publications

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Use of Apixaban in Children Awaiting Heart Transplantation

Use of apixaban in children awaiting heart transplantation

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