Usefulness of Direct Oral Anticoagulants in Adult Congenital Heart Disease

Pujol, C.; Niesert, Anne‐Charlotte; Engelhardt, A.; Schoen, Patric; Kusmenkov, Ekatharina; Pittrow, David; Ewert, Peter; Kaemmerer, Harald

doi:10.1016/j.amjcard.2015.10.062

Cited by 69 publications

(52 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, Pujol et al 25 reported retrospective data regarding use of DOACs in ACHD. During a mean follow-up period of 12±11 months, no relevant side effects and no major bleeding were observed.…”

Section: Acute Treatment Of Svt In Achdmentioning

confidence: 99%

Management of supraventricular arrhythmias in adults with congenital heart disease

Wasmer

Eckardt

2016

Heart

View full text Add to dashboard Cite

Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines.

show abstract

Section: Acute Treatment Of Svt In Achdmentioning

confidence: 99%

Management of supraventricular arrhythmias in adults with congenital heart disease

Wasmer

Eckardt

2016

Heart

View full text Add to dashboard Cite

show abstract

“…The advent of newer oral anticoagulants offers an exciting opportunity for improved therapy in these patients but requires rigorous study before it can be recommended in standard practice. [29]…”

Section: Discussionmentioning

confidence: 99%

Thromboembolism and anticoagulation after fontan surgery

Sangeetha

2016

Ann Pediatr Card

View full text Add to dashboard Cite

This review attempts to answer the common questions faced by a clinician regarding thromboembolism and thromboprophylaxis in patients following Fontan surgery. The review is in an easy to understand question and answer format and discusses the currently available literature on the subject in an attempt to arrive at practical clinically relevant solutions. Patients who have undergone the Fontan operation are at a high risk for thromboembolism. Based on available evidence, there is a strong rationale for thromboprophylaxis. However, it is not clear as to which agent should be administered to prevent thromboembolic events. While the available evidence suggests that antiplatelet agents alone may be as good as oral anticoagulants, there is a need for a large multicenter randomized control trial comparing these two common strategies to deliver a clear verdict.

show abstract

“…Limited data is available regarding the use of NOACs in ACHD population. One prospective study included data from 75 ACHD patients without prosthetic heart valves taking one of three NOACs[99]. Twenty-one percent of participants had complex CHD and the main indication was thrombosis prevention in atrial arrhythmia[99].…”

Section: Management Of Chronic or Recurrent Atrial Arrhythmias In Achmentioning

confidence: 99%

“…One prospective study included data from 75 ACHD patients without prosthetic heart valves taking one of three NOACs[99]. Twenty-one percent of participants had complex CHD and the main indication was thrombosis prevention in atrial arrhythmia[99]. During a mean follow-up duration of 12 mo, there were no thrombotic or major bleeding events[99].…”

Section: Management Of Chronic or Recurrent Atrial Arrhythmias In Achmentioning

confidence: 99%

Atrial tachyarrhythmia in adult congenital heart disease

Karbassi¹,

Nair²,

Harris³

et al. 2017

WJC

View full text Add to dashboard Cite

The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration.

show abstract

Usefulness of Direct Oral Anticoagulants in Adult Congenital Heart Disease

Cited by 69 publications

References 28 publications

Management of supraventricular arrhythmias in adults with congenital heart disease

Management of supraventricular arrhythmias in adults with congenital heart disease

Thromboembolism and anticoagulation after fontan surgery

Atrial tachyarrhythmia in adult congenital heart disease

Contact Info

Product

Resources

About