TY - EJOU
AU - Arslani, Ketina
AU - Notz, Lukas
AU - Zurek, Marzena
AU - Greutmann, Matthias
AU - Schwerzmann, Markus
AU - Bouchardy, Judith
AU - Engel, Reto
AU - Jost, Christine Attenhofer
AU - Tobler, Daniel
TI - Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland
T2 - Congenital Heart Disease
PY - 2018
VL - 13
IS - 5
SN - 1747-0803
AB - Background: In adults with congenital heart disease (CHD) and atrial arrhythmias, recommendations for thromboprophylaxis are vague and evidence is lacking. We aimed to identify factors that
influence decision-making in daily practice.
Methods: From the Swiss Adult Congenital HEart disease Registry (SACHER) we identified 241
patients with either atrial fibrillation (Afib) or atrial flutter/intraatrial reentrant tachycardia (Aflut/
IART). The mode of anticoagulation was reviewed. Logistic regression models were used to assess
factors that were associated with oral anticoagulation therapy.
Results: Compared with patients with Aflut/IART, patients with Afib were older (51 ± 16.1 vs
37 ± 16 years, P < .001) and had a higher CHA2DS2-VASc (P < .001) and HAS-BLED scores (P =
.005). Patients with Afib were more likely on oral anticoagulation than patients with Aflut/IART
(67% vs 43%, P < .001). In a multivariate logistic regression model, age [odds ratio (OR) 1.03 per
year, 95%CI (1.01-1.05), P = .019], atrial fibrillation [OR 2.75, 95%CI (1.30-5.08), P = .007], nonparoxysmal atrial arrhythmias [OR 5.33, 95%CI (2.21-12.85)], CHA2DS2-VASc-Score >1 [OR 2.93,
95%CI (1.87-4.61), P < .001], and Fontan palliation [OR 17.5, 95%CI (5.57-54.97), P < .001] were
independently associated with oral anticoagulation treatment, whereas a HAS-BLED score >1 was
associated with absence of thromboprophylaxis [OR 0.32, 95%CI (0.17-0.60), P < .001].
Conclusions: In this multicenter study, age, type, and duration of atrial arrhythmias, CHA2DS2-
VASc and HAS-BLED scores as well as a Fontan palliation had an impact on the use of thromboprophylaxis in adult CHD patients with atrial arrhythmias. In daily practice, anticoagulation
strategies differ between patients with Afib and those with Aflut/IART. Prospective observational
studies are necessary to clarify whether this attitude is justified.
KW - anticoagulation
KW - atrial arrhythmia
KW - congenital heart disease
KW - thromboprophylaxis
DO - 10.1111/chd.12627