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A Narrative Review of Postoperative Anticoagulation Therapy for Congenital Cardiac Disease
Alexander A Boucher1, Julia A Heneghan2, Subin Jang3
1Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States.
Insights
Postoperative thromboprophylaxis after congenital heart defect surgeries shows wide practice variations. More research is needed to standardize the use of anticoagulants and antiplatelet agents in pediatric patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pharmacology
Background:
- Congenital heart disease (CHD) necessitates surgical interventions, often requiring thromboprophylaxis for device patency.
- Current antiplatelet and anticoagulant strategies in pediatric CHD patients lack standardization and guideline alignment.
- Emerging direct oral anticoagulants are increasingly used in children but are not widely covered in consensus guidelines.
Purpose of the Study:
- To review the literature on postoperative thromboprophylaxis in pediatric patients undergoing surgery for congenital heart disease.
- To identify current practices, variability, and gaps in evidence regarding anticoagulant and antiplatelet use.
- To highlight the need for further research to establish standardized thromboprophylaxis protocols.
Main Methods:
- A narrative review of studies published between 2011 and 2021.
- Focus on pediatric studies involving heart valve replacement/repair, shunts, conduits, and other CHD operations.
- Literature search concentrated on descriptions and outcomes of thromboprophylaxis strategies.
Main Results:
- Significant variability in antiplatelet and anticoagulant management practices was observed.
- Aspirin, warfarin, and heparin remain common but are used with inconsistent dosing, duration, and monitoring.
- Limited randomized controlled trials exist, and recent data on direct oral anticoagulants in children are emerging.
Conclusions:
- Existing thromboprophylaxis strategies after pediatric CHD surgery are highly variable.
- There is a critical need for more robust research to develop evidence-based, standardized protocols.
- Standardization of thromboprophylaxis is essential for optimizing outcomes in pediatric CHD patients.
Abstract:
Congenital heart disease encompasses a range of cardiac birth defects. Some defects require early and complex surgical intervention and post-operative thromboprophylaxis primarily for valve, conduit, and shunt patency. Antiplatelet and anticoagulant management strategies vary considerably and may or may not align with recognized consensus practice guidelines. In addition, newer anticoagulant agents are being increasingly used in children, but these medications are not addressed in most consensus statements. This narrative review evaluated the literature from 2011 through 2021 on the topic of postoperative thromboprophylaxis after congenital heart disease operations. The search was focused on the descriptions and results of pediatric studies for replacement and/or repair of heart valves, shunts, conduits, and other congenital heart disease operations. Wide variability in practice exists and, as was true a decade ago, few randomized controlled trials have been conducted. Aspirin, warfarin, and perioperative heparin remain the most commonly used agents with varying dosing, duration, and monitoring strategies, making comparisons difficult. Only recently have data on direct oral anticoagulants been published in children, suggesting evolving paradigms of care. Our findings highlight the need for more research to strengthen the evidence for standardized thromboprophylaxis strategies.
