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Thromboembolism and the role of anticoagulation in the Fontan patient

M L Jacobs1, K K Pourmoghadam

  • 1Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134, USA. Marshall.Jacobs@tenethealth.com

Pediatric Cardiology
|September 1, 2007
PubMed

Insights

Thromboembolic complications are a major cause of morbidity and failure in Fontan circulation. Addressing this complex issue likely requires a multifaceted approach rather than a single solution.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Hematology

Background:

  • Thromboembolic complications significantly contribute to morbidity and Fontan circulation failure.
  • Potential causes include low flow, venous stasis, shunts, prosthetic materials, arrhythmias, and hypercoagulable states.

Purpose of the Study:

  • To review and characterize thromboembolic events following Fontan operations.
  • To identify patient, surgical, hemodynamic, and hematologic factors associated with thromboembolic risk.
  • To examine current prophylactic anticoagulation strategies.

Main Methods:

  • Literature review of retrospective investigations.
  • Analysis of factors contributing to thromboembolism.
  • Assessment of varying anticoagulation practices.

Main Results:

  • Thromboembolic events are multifactorial, arising from complex biologic interactions.
  • Risk factors are diverse, encompassing patient-specific and surgical elements.
  • Current prophylactic strategies show wide variation.

Conclusions:

  • Thromboembolism after Fontan operations is a complex problem with multiple interacting factors.
  • A single therapeutic agent is unlikely to resolve this issue.
  • Further research into integrated management strategies is warranted.

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