@Article{chd.12603,
AUTHOR = {Justin Georgekutty, Amir Kazerouninia, YunFei Wang, Peter R. Ermis, Dhaval R. Parekh, Wayne J. Franklin, Wilson W. Lam},
TITLE = {Novel oral anticoagulant use in adult Fontan patients: A single center experience},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {4},
PAGES = {541--547},
URL = {http://www.techscience.com/schd/v13n4/39021},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Adult Fontan patients are at increased risk for thrombosis and thromboembolic complications leading to increased morbidity and mortality. Most are prescribed antiplatelet or
anticoagulant therapy for thromboprophylaxis; novel oral anticoagulants (NOACs) are uncommonly
used given lack of data on their use in this population and generalized concerns regarding Fontan
patients’ abnormal coagulation. We report the largest single-center experience with the use of
NOACs for treatment and prophylaxis of thrombosis and thromboembolism in adult Fontan
patients.<br/>
<b>Results:</b> A retrospective chart review identified 21 patients (11 female, 10 male), median age 33
years (18-50) at first initiation, who were prescribed a NOAC on 27 different occasions. The main
indications for anticoagulation were arrhythmia (N = 12), thrombosis (N = 8), and persistent right
to left shunts (N = 2); one patient was initially on anticoagulation for arrhythmia but restarted for
thrombosis. The most common indications for initiation of a NOAC over warfarin were patient/
provider preference (N = 11), labile international normalized ratio (INR) (N = 5), initiation of therapy elsewhere (N = 3), and history of poor clinical follow-up (N = 2). Over a cumulative 316
months of patient therapy, one new thrombotic event was noted. No major or nonmajor bleeding
events occurred, and 10 patients experienced minor bleeding that did not require the cessation of
therapy. One patient died from multiorgan system failure following an unwitnessed, out of hospital
arrest. At present, 10 patients remain on NOAC therapy in the setting of ongoing arrhythmia
(N = 4), history of stroke (N = 2), history of pulmonary embolism (N = 2), history of deep vein
thrombosis (N = 1), and history of right ventricle thrombus (N = 1).<br/>
<b>Conclusions:</b> While our study is limited by size, our results suggest that NOACs may be a noninferior alternative to traditional anticoagulation and that further study is warranted.},
DOI = {10.1111/chd.12603}
}