Optimal Strategy for Thromboprophylaxis in Fontan Circulation: A Systematic Review and Meta-analysis with a Focus on...

Area of Science:

• Cardiovascular Medicine
• Hematology
• Pediatric Cardiology

Background:

• Fontan circulation, a surgical repair for single-ventricle defects, alters hemodynamics.
• These alterations elevate the risk of thromboembolism, necessitating effective thromboprophylaxis.
• Personalized and ethnicity-based strategies are crucial for optimizing treatment.

Purpose of the Study:

• To assess optimal thromboprophylaxis regimens for patients with Fontan circulation.
• To compare the efficacy of aspirin, warfarin, and direct oral anticoagulants (DOACs) against no antithrombotic therapy.
• To investigate ethnicity-based differences in treatment effectiveness, particularly in East Asian populations.

Main Methods:

• A comprehensive meta-analysis of literature from PubMed, Embase, and Cochrane Library.
• Inclusion of 30 reports: 4 randomized controlled trials and 26 cohort studies.
• Analysis of thromboembolic and bleeding outcomes across different antithrombotic regimens.

Main Results:

• Warfarin significantly reduced thromboembolic risk (RR, 0.40; p < 0.001) compared to no intervention.
• Aspirin (RR, 0.46; p = 0.07) and DOACs (RR, 0.22; p = 0.4) did not show statistically significant risk reduction.
• In East Asian subgroups, aspirin significantly reduced risk (RR, 0.31; p < 0.001) and was more effective than warfarin (RR, 0.57; p = 0.01).
• No significant differences in bleeding risk were observed between groups.

Conclusions:

• Thromboprophylaxis in Fontan circulation patients reduces thromboembolic risk.
• Warfarin is effective overall, but aspirin may be superior in East Asian patients.
• Further research into ethnicity-tailored thromboprophylaxis strategies is warranted due to limited data.