Coagulation and Anticoagulation in Fontan Patients

Area of Science:

• Cardiology
• Pediatric Cardiology
• Hematology

Background:

• Fontan circulation is associated with a significant risk of thromboembolic events.
• These events can lead to Fontan circulation failure, stroke, and mortality.
• Current management strategies lack consensus, particularly regarding antithrombotic therapy.

Purpose of the Study:

• To review existing literature on antithrombotic prophylaxis and treatment in Fontan patients.
• To address controversies surrounding thromboembolic event substrates, risk factors, and detection.
• To propose a decision-tree algorithm for thromboprophylaxis in this population.

Main Methods:

• Comprehensive literature review of antithrombotic strategies for Fontan patients.
• Analysis of epidemiology, pathophysiology, and detection of thromboembolic events.
• Development of a clinical decision-tree for thromboprophylaxis.

Main Results:

• Identified significant risks and clinical implications of thromboembolic events in Fontan circulation.
• Highlighted controversies and evidence gaps in current management.
• Proposed a structured approach to thromboprophylaxis.

Conclusions:

• Optimal antithrombotic therapy for Fontan patients remains an area requiring further research and consensus.
• The proposed decision-tree offers a practical tool for clinical guidance.
• Further investigation into evidence gaps is crucial for improving patient outcomes.