[Congenital cardiopathy: indications for anticoagulant treatment]

Congenital cardiopathy is common in children with thromboembolic disease. There are no objective clinical data for medium and long term treatment. Vitamin K antagonists could be envisaged for this. Children with a mechanical valve should be anticoagulated. This has been validated in adults, there has been no study in children which contradicts this, and the serious nature of thromboembolic complications in this group is significant. In atrial fibrillation, the most frequent indication for oral anticoagulants is after a Fontan procedure, because of the thromboembolic risk factors. Anticoagulation following Fontan or similar procedures relies on the thrombotic factors and their temporal distribution, being more pronounced in the first postoperative year; anticoagulants should be given over this period. In Eisenmenger's syndrome haemorrhage is common: these patients are not anticoagulated unless there is an indication such as recent pulmonary embolus. During interventional catheterisation thromboembolic accidents are rare, occurring early, and more commonly with certain prostheses. In adults with an intra-atrial prosthesis oral anticoagulants are used for three months, and then replaced by antiplatelet drugs. In congenital cardiopathy the stent is often pulmonary or aortic, and the incidence of thromboembolic accident is therefore very low. For a venous channel or in the context of a Fontan procedure, oral anticoagulants are justified for between three and six months. It is to be hoped that prospective studies, of which some are in progress, will provide further guidance for these indications.