%0 Journal Article
%T Thromboprophylaxis in Adults With Atrio
%A Adam J. Small
%A Gentian Lluri
%A Jamil A. Aboulhosn
%J World Journal for Pediatric and Congenital Heart Surgery
%@ 2150-136X
%D 2018
%R 10.1177/2150135118772837
%X Although aspirin has been compared to warfarin for thromboembolic prophylaxis in the general Fontan population, little is known about the optimal preventative strategy for the atriopulmonary right atrium¨Cpulmonary artery [RA-PA]) Fontan particularly. A retrospective cohort study was performed including adult patients identified in the Ahmanson/UCLA Adult Congenital Heart Disease Center database with a history of RA-PA Fontan and use of either aspirin or warfarin as most recent primary prophylaxis against thromboembolism. Primary outcome was incident thromboembolism, defined as space-occupying lesion on imaging consistent with thrombus within the Fontan or pulmonary arterial circuit. Secondary outcomes were death, transplantation, Fontan conversion, and bleeding requiring either transfusion or invasive intervention. Follow-up was terminated upon achievement of a primary outcome or achievement of a secondary outcome other than bleeding. Kaplan-Meier analysis of freedom from thrombosis was performed. Twenty-six patients met inclusion criteria. Thirteen (50%) received aspirin as most recent primary prophylaxis and 13 (50%) received warfarin. Tricuspid atresia was the most common underlying diagnosis (42%), followed by double-inlet left ventricle (38%). Median age at Fontan operation was 8.2 years; median age at prophylaxis initiation was 25.9 years. After six years, the aspirin group had 50% ˇŔ 35% freedom from thrombosis and the warfarin group 92% ˇŔ 8% (P = .15). Incidences of secondary outcomes were not significantly different between the groups. In this cohort of long-term Fontan survivors with RA-PA Fontan, the risk of thromboembolic complications is high, especially in those taking aspirin rather than warfarin. Larger studies are needed to confirm these findings
%K adult congenital heart disease
%K Fontan
%K thrombosis (intracardiac)
%K CHD (univentricular heart)
%K congenital heart surgery
%U https://journals.sagepub.com/doi/full/10.1177/2150135118772837