Coagulation and Anticoagulation in Fontan Patients

Management of Fontan failure

“…The choice between vitamin K antagonist (VKA) and non-vitamin K oral anticoagulants (NOACs) is poorly supported by data. However, in recent studies, NOACs appeared to be safe and effective in the short term for thromboprophylaxis in Fontan patients with a significantly quality of life improvement 23…”

“…In adults, we recommend baseline lifelong low-dose aspirin. Systemic anticoagulation is considered in selected patients such as in patients with arrhythmias, history of thrombotic complication, systemic desaturation (<90%), open fenestration, PLE/refractory ascites and ventricular dysfunction 2 10 11 23…”

“…Despite limited data regarding safety or efficacy of NOAC therapy in Fontan patients, these drugs are increasingly considered unless specific contraindication 23…”

“…However, thrombus resolution is reported in variable cases from 16% to 47% in literature. As a secondary preventive measure in adult patients, it is recommended that they continue VKA treatment, after resolution of the thrombus, while indications for children are less clear and depend on risk factors 10 11 23…”

“…However, the decision on systemic thrombolysis should be considered in PE with haemodynamic instability and should be made in a multidisciplinary team. Surgical or percutaneous embolectomy is another option to consider in case of haemodynamic instability despite anticoagulation treatment 23…”