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Thromboprophylaxis in Patients With Fontan Circulation
Jef Van den Eynde1, Mathias Possner2, Fares Alahdab3
1Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA; Department of Cardiovascular Diseases, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. Electronic address: https://twitter.com/JefVandenEynde.
Journal of the American College of Cardiology
|January 25, 2023
Summary
For Fontan circulation patients, aspirin, warfarin, and non-vitamin K oral anticoagulants (NOACs) reduce thromboembolic events. While all are effective, aspirin may offer the most favorable safety profile in this population.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Optimal thromboprophylaxis strategy for Fontan circulation remains undetermined.
- Patients with Fontan circulation are at increased risk for thromboembolic events.
Purpose of the Study:
- To compare the efficacy and safety of aspirin, warfarin, and non-vitamin K oral anticoagulants (NOACs) for thromboprophylaxis in Fontan circulation patients.
- To identify the most effective and safest antithrombotic agent through a network meta-analysis.
Main Methods:
- A systematic literature search identified 21 studies published by February 2022.
- Frequentist network meta-analyses were performed to assess thromboembolic events and major bleeding rates.
- Treatment rankings were determined using probability (P) scores to evaluate overall treatment profiles.
Main Results:
- Aspirin, warfarin, and NOACs significantly reduced thromboembolic events compared to no thromboprophylaxis.
- No significant differences in major bleeding rates were observed among aspirin, warfarin, and NOACs.
- NOACs demonstrated the highest probability score for preventing thromboembolic events, though aspirin showed a favorable overall profile.
Conclusions:
- Aspirin, warfarin, and NOACs are effective in reducing thromboembolic risk in Fontan circulation patients.
- The study supports the safety and efficacy of NOACs, despite limitations in patient numbers and study heterogeneity.
- Aspirin emerged as a potentially favorable option, warranting further investigation.
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