Thromboprophylaxis in Adults With Atrio-Pulmonary Fontan

World Journal for Pediatric & Congenital Heart Surgery
Adam J SmallGentian Lluri

Abstract

Although aspirin has been compared to warfarin for thromboembolic prophylaxis in the general Fontan population, little is known about the optimal preventative strategy for the atriopulmonary right atrium-pulmonary artery [RA-PA]) Fontan particularly. A retrospective cohort study was performed including adult patients identified in the Ahmanson/UCLA Adult Congenital Heart Disease Center database with a history of RA-PA Fontan and use of either aspirin or warfarin as most recent primary prophylaxis against thromboembolism. Primary outcome was incident thromboembolism, defined as space-occupying lesion on imaging consistent with thrombus within the Fontan or pulmonary arterial circuit. Secondary outcomes were death, transplantation, Fontan conversion, and bleeding requiring either transfusion or invasive intervention. Follow-up was terminated upon achievement of a primary outcome or achievement of a secondary outcome other than bleeding. Kaplan-Meier analysis of freedom from thrombosis was performed. Twenty-six patients met inclusion criteria. Thirteen (50%) received aspirin as most recent primary prophylaxis and 13 (50%) received warfarin. Tricuspid atresia was the most common underlying diagnosis (42%), followed by double-inlet ...Continue Reading

References

May 1, 1971·Thorax·F Fontan, E Baudet
Mar 25, 2000·The Journal of Thoracic and Cardiovascular Surgery·G BallingJ Hess
Jun 28, 2001·The Annals of Thoracic Surgery·P D CoonT L Spray
Jul 12, 2005·International Journal of Cardiology·Y F CheungL C Cheng
Jul 30, 2011·Journal of the American College of Cardiology·Paul MonagleUNKNOWN Fontan Anticoagulation Study Group
Jul 31, 2013·The Journal of Thoracic and Cardiovascular Surgery·Lidia Tomkiewicz-PajakAnetta Undas
Sep 1, 2015·Heart·Tarek AlsaiedGruschen R Veldtman
Oct 10, 2015·Journal of the American College of Cardiology·Kavitha N PundiFrank Cetta
Sep 17, 2016·Journal of the American College of Cardiology·Alexander C EgbeDavid J Driscoll

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