Strategies for thromboprophylaxis in Fontan circulation: a meta-analysis

Alsaied, Tarek; Alsidawi, Said; Allen, Casey L.; Faircloth, Jenna M.; Palumbo, Joseph S.; Veldtman, Gruschen

doi:10.1136/heartjnl-2015-307930

Cited by 109 publications

(87 citation statements)

References 35 publications

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“…Risk factors for thrombosis include haemodynamic factors with low cardiac output and less pulsatile pulmonary flow in addition to a hypercoagulable state in Fontan patients 29. A recent meta-analysis showed a pooled incidence of 11% and that prophylaxis with aspirin or warfarin decreases the risk significantly (OR 0.4, 95% CI 0.19 to 0.92) 29. The location of thrombus is most commonly in the Fontan conduit, intracardiac or in the pulmonary arteries 15 29 30…”

Section: Predictors Of Long-term Mortalitymentioning

confidence: 99%

Factors associated with long-term mortality after Fontan procedures: a systematic review

Alsaied

Bokma

Engel

et al. 2016

Heart

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118

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Section: Predictors Of Long-term Mortalitymentioning

confidence: 99%

Factors associated with long-term mortality after Fontan procedures: a systematic review

Alsaied

Bokma

Engel

et al. 2016

Heart

Self Cite

118

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“…241 There is no consensus as to whether antiplatelet therapy is adequate or therapeutic anticoagulation is needed in the absence of previous thromboembolism or arrhythmia, but limited data suggest equal efficacy of either strategy. 241,242 The relative safety and efficacy of non-vitamin K antagonist oral anticoagulants in adults with CHD have not been established, but multicenter trials are ongoing.…”

Section: 240mentioning

confidence: 99%

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lui¹,

Saïdi²,

Bhatt³

et al. 2017

Circulation

173

136

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ABSTRACT:Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.

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“…In addition to the aforementioned sluggish blow flow through the Fontan circuit, a hypercoagulable state develops in patients following the procedure: the levels of protein C, protein S and antithrombin III are low, while the level of factor VIII is elevated 14. The pathogenesis behind this imbalance is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Embolic stroke in a postpartum patient with Fontan physiology

VanHise¹,

Smith

et al. 2018

BMJ Case Reports

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In cardiac physiology, single ventricle typically refers to the presence of a dominant systemic ventricle along with a hypoplastic ventricle. The Fontan operation is used to repair the single ventricle by directing deoxygenated systemic venous flow to the pulmonary arterial circulation. Normal pregnancy physiology, particularly increased intravascular volume, increased heart rate, increased cardiac output, hypercoagulability and decreased systemic vascular resistance, can exacerbate cardiac disease in patients with Fontan circulation, leading to pregnancy complications. Despite the known risks, there are limited data addressing the question of anticoagulation in pregnant patients with Fontan physiology. Herein we present the case of a Fontan patient who had a successful pregnancy and delivery, and developed an embolic stroke in the postpartum period.

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Strategies for thromboprophylaxis in Fontan circulation: a meta-analysis

Abstract: This study shows a significantly lower incidence of TE after Fontan procedure if either aspirin or warfarin is used. This meta-analysis suggests no significant difference in incidence of early or late TE in patients receiving aspirin compared with warfarin.

Cited by 109 publications

References 35 publications

Factors associated with long-term mortality after Fontan procedures: a systematic review

Factors associated with long-term mortality after Fontan procedures: a systematic review

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Embolic stroke in a postpartum patient with Fontan physiology

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