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Article: Long-term anticoagulation therapy and thromboembolic complications after the Fontan procedure

TitleLong-term anticoagulation therapy and thromboembolic complications after the Fontan procedure
Authors
Issue Date2005
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcard
Citation
International Journal Of Cardiology, 2005, v. 102 n. 3, p. 509-513 How to Cite?
AbstractBackground: The necessity for chronic anticoagulation of Fontan patients remains controversial. We determined the prevalence of thromboembolic complications after the Fontan procedure in relation to different long-term anticoagulation strategies. Methods: The clinical outcomes, postoperative anticoagulation strategies and occurrence of thromboembolic complications in 102 ethnic Chinese patients who had undergone Fontan procedure between 1980 and 2002 were reviewed. Results: The early and late surgical mortalities, all unrelated to thromboembolism, were 10.8% (11/102) and 5.8% (6/104), respectively. Of the 85 survivors, 46 (54%) were maintained on long-term warfarin therapy, 8 (9%) on aspirin prophylaxis while 31 (37%) were not on chronic anticoagulation. Four (4.5%) patients, two with and two without warfarin prophylaxis, developed thromboembolic complications at 0.14 to 7.7 years after the Fontan procedure (0.74%/patient-year). Three had a grossly dilated right atrium after atriopulmonary connection, two of whom had atrial fenestrations. The other had atrial tachycardia. Freedom from development of thromboembolic complications (mean±S.E.) at 1, 5 and 10 years after surgery was 97±19%, 96±2.5% and 92±4.2%, respectively. When compared with those on long-term warfarin therapy, patients without chronic anticoagulation were followed-up longer (p=0.001), more likely to have undergone atriopulmonary connection (p<0.001), less likely to have fenestrations (p=0.02) and cardiac arrhythmias (p=0.02) but not predisposed to increased risk of thromboembolism (p=1.00). Conclusion: The study supports the contention that chronic anticoagulation may not be required for majority of ethnic Chinese Fontan patients. Nonetheless, it may perhaps be considered in those with grossly dilated right atrium, cardiac arrhythmias and residual right-to-left shunts. © 2004 Elsevier Ireland Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/170342
ISSN
2015 Impact Factor: 4.638
2015 SCImago Journal Rankings: 1.513
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_US
dc.contributor.authorChay, GWen_US
dc.contributor.authorChiu, CSWen_US
dc.contributor.authorCheng, LCen_US
dc.date.accessioned2012-10-30T06:07:38Z-
dc.date.available2012-10-30T06:07:38Z-
dc.date.issued2005en_US
dc.identifier.citationInternational Journal Of Cardiology, 2005, v. 102 n. 3, p. 509-513en_US
dc.identifier.issn0167-5273en_US
dc.identifier.urihttp://hdl.handle.net/10722/170342-
dc.description.abstractBackground: The necessity for chronic anticoagulation of Fontan patients remains controversial. We determined the prevalence of thromboembolic complications after the Fontan procedure in relation to different long-term anticoagulation strategies. Methods: The clinical outcomes, postoperative anticoagulation strategies and occurrence of thromboembolic complications in 102 ethnic Chinese patients who had undergone Fontan procedure between 1980 and 2002 were reviewed. Results: The early and late surgical mortalities, all unrelated to thromboembolism, were 10.8% (11/102) and 5.8% (6/104), respectively. Of the 85 survivors, 46 (54%) were maintained on long-term warfarin therapy, 8 (9%) on aspirin prophylaxis while 31 (37%) were not on chronic anticoagulation. Four (4.5%) patients, two with and two without warfarin prophylaxis, developed thromboembolic complications at 0.14 to 7.7 years after the Fontan procedure (0.74%/patient-year). Three had a grossly dilated right atrium after atriopulmonary connection, two of whom had atrial fenestrations. The other had atrial tachycardia. Freedom from development of thromboembolic complications (mean±S.E.) at 1, 5 and 10 years after surgery was 97±19%, 96±2.5% and 92±4.2%, respectively. When compared with those on long-term warfarin therapy, patients without chronic anticoagulation were followed-up longer (p=0.001), more likely to have undergone atriopulmonary connection (p<0.001), less likely to have fenestrations (p=0.02) and cardiac arrhythmias (p=0.02) but not predisposed to increased risk of thromboembolism (p=1.00). Conclusion: The study supports the contention that chronic anticoagulation may not be required for majority of ethnic Chinese Fontan patients. Nonetheless, it may perhaps be considered in those with grossly dilated right atrium, cardiac arrhythmias and residual right-to-left shunts. © 2004 Elsevier Ireland Ltd. All rights reserved.en_US
dc.languageengen_US
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcarden_US
dc.relation.ispartofInternational Journal of Cardiologyen_US
dc.subject.meshAnticoagulants - Therapeutic Useen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshFontan Procedure - Adverse Effectsen_US
dc.subject.meshHeart Defects, Congenital - Surgeryen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Assessmenten_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshThromboembolism - Etiology - Prevention & Controlen_US
dc.subject.meshTime Factorsen_US
dc.subject.meshWarfarin - Therapeutic Useen_US
dc.titleLong-term anticoagulation therapy and thromboembolic complications after the Fontan procedureen_US
dc.typeArticleen_US
dc.identifier.emailCheung, YF:xfcheung@hku.hken_US
dc.identifier.authorityCheung, YF=rp00382en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/j.ijcard.2004.05.051en_US
dc.identifier.pmid16004898-
dc.identifier.scopuseid_2-s2.0-21844437121en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-21844437121&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume102en_US
dc.identifier.issue3en_US
dc.identifier.spage509en_US
dc.identifier.epage513en_US
dc.identifier.isiWOS:000230856200019-
dc.publisher.placeIrelanden_US
dc.identifier.scopusauthoridCheung, YF=7202111067en_US
dc.identifier.scopusauthoridChay, GW=9435530600en_US
dc.identifier.scopusauthoridChiu, CSW=8714554800en_US
dc.identifier.scopusauthoridCheng, LC=9533935800en_US

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