Author + information
- Justin Georgekuttya,b,
- Amir Kazerouniniaa,b,
- Peter Ermisa,b,
- Dhaval Parekha,b,
- Wayne Franklina,b and
- Wilson Lama,b
Background: Thromboembolic complications are a leading cause of morbidity and mortality in patients with Fontan physiology. Current clinical practice for prevention and treatment of these complications involves the use of vitamin K antagonists and/or antiplatelet agents. Novel oral anticoagulants (NOACs) are gaining more widespread use in adult patients with nonvalvular heart disease given the lack of a need for dietary modification, no lab monitoring and fewer drug-drug interactions. We report the use of NOACs in a cohort of adult Fontan patients.
Methods: A retrospective analysis of a cohort of adult Fontan patients on NOAC therapy was conducted. Demographics, underlying anatomy, NOAC used, indication for therapy, duration of therapy, thromboembolic events and bleeding events were obtained from the medical record. A CHA2DS2-VASc and HAS-BLED score were assigned to each patient based on clinical data available on the day of initiation of NOAC therapy. The study was approved by the Institutional Review Board of Baylor College of Medicine.
Results: Nineteen patients (10 women) were prescribed NOAC therapy with apixaban (N=13), rivaroxaban (N=4) and dabigatran (N=2) at a median age of 32 years (18-50). The primary indication for therapy was current arrhythmia (N=11), post arrhythmia procedure (N=3), thrombosis (N=3) and cyanosis with right to left shunting (N=2). The median CHA2DS2-VASc score was 1 (0-3) and HAS-BLED score was 2 (0-3). The median duration of therapy was 7 months (1-46) with a total of 225 patient months on therapy. There were no thromboembolic complications. Three patients had easy bruising, one patient had occasional hemorrhoid bleeding which was present prior to therapy and one patient had gastrointestinal bleeding related to biliary tree stenting. None of these patients required cessation of therapy. Thirteen patients remain on active NOAC therapy.
Conclusions: NOAC therapy in adults with Fontan palliation may be considered as a safe alternative for the prevention and treatment of thromboembolic complications. Further investigation is required to investigate long term safety and outcomes of NOACs in the Fontan population.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Redefining the “F” Word
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1270-012
- 2017 American College of Cardiology Foundation