Anticoagulation Therapy After the Fontan Procedure

Miwa, Koji; Iwai, Shigemitsu; Nagashima, Toshiaki

doi:10.1007/s00246-022-02848-6

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…We previously reported that the PT-INR is difficult to control in patients who are administered warfarin, particularly during the early phase after TCPC. 19 In younger patients, the PT-INR varies easily, even with the same warfarin dose; therefore, patients need to undergo frequent blood tests for PT-INR assessment. However, this makes lifelong warfarin control challenging.…”

Section: Commentmentioning

confidence: 99%

“…Our anticoagulation regimen for patients undergoing the fenestrated Fontan procedure has been described previously. 19 The patients were continuously administered aspirin (initial dose: 5 mg/kg/d) and received combined administration of warfarin immediately after the procedure; that is, before hospital discharge. The prothrombin time-international normalized ratio (PT-INR) was controlled to 1.5 to 2.0.…”

Section: Anticoagulation Regimenmentioning

confidence: 99%

“…However, this makes lifelong warfarin control challenging. 19 In terms of the surgical technique used for fenestration, many institutions have adopted direct side-to-side anastomosis, and the rates of spontaneous closure with this procedure are 30% to 60%. 5 Some reports suggest the possibility of a difference in the rate of spontaneous fenestration closure using surgical techniques.…”

Section: Incidence and Factors Influencing Fenestration Closurementioning

confidence: 99%

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Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Miwa,

Iwai,

Kanaya

et al. 2023

World J Pediatr Congenit Heart Surg

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Background We aimed to analyze mid-term outcomes of the fenestrated Fontan procedure, focusing on the fenestration size. Methods We retrospectively reviewed the outcomes of the fenestrated Fontan procedure. Among 165 patients who underwent the Fontan procedure from 2011 to 2021, fenestration was created in 27 patients with the highest risks, including those with hypoplastic left heart syndrome, hypoplastic pulmonary arteries, heterotaxy syndrome with high pulmonary vascular resistance, and pulmonary arterial pressure >15 mm Hg. The patients underwent the procedure at a median age of three years (body weight, 11.4 kg; body surface area, 0.54 m2). Fenestration sizes were 3.5 to 5 mm. Results Spontaneous fenestration closure occurred within one year postoperatively in nine patients. Among them, three experienced Fontan failure, necessitating refenestration. Although fenestration size did not differ, the size corrected by body surface area at the time of surgery was smaller in patients with fenestration closure (6.4 mm/m2 vs 8.3 mm/m2, P < .05). Patients with a fenestration <7 mm/m2 were more likely to have fenestration closure within one year postoperatively, and those with a fenestration >9 mm/m2 were more likely to have severe desaturation and require home oxygen therapy following discharge. Conclusions Spontaneous fenestration closure affected the frequency of Fontan complications. A very small fenestration size corrected by body surface area was a significant risk factor for spontaneous closure. Conversely, a very large fenestration size corrected by body surface area resulted in severe desaturation. The optimal fenestration size to prevent early spontaneous closure and severe desaturation is approximately 8 mm/m2.

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Section: Commentmentioning

confidence: 99%

Section: Anticoagulation Regimenmentioning

confidence: 99%

Section: Incidence and Factors Influencing Fenestration Closurementioning

confidence: 99%

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Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Miwa,

Iwai,

Kanaya

et al. 2023

World J Pediatr Congenit Heart Surg

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Real-World Use and Outcomes of Apixaban for Early Post-Surgical Fontan Thromboprophylaxis

Adkins,

Williams,

Esteso

et al. 2024

Pediatr Cardiol

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Association between warfarin use and thromboembolic events in patients post-Fontan operation: propensity-score overlap weighting analyses

Maki,

Aso,

Inuzuka

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The appropriate antithrombotic regimen after a Fontan operation is yet to be elucidated. Hence, this study aimed to compare the incidence of thromboembolic events in patients with and without receiving warfarin for thromboprophylaxis in a large post-Fontan population. METHODS This retrospective cohort study used data from the Diagnosis Procedure Combination database in Japan, between April 2011 and March 2022. We identified all patients who underwent a Fontan operation and excluded those who were born before 2010, died during the hospitalization, or received mechanical heart replacement. Propensity score overlap weighting was performed between patients discharged with warfarin (with or without aspirin) and the control group (only aspirin, or neither aspirin nor warfarin). Cox and Fine-Gray hazards models compared thromboembolic and bleeding events. RESULTS We identified 2,007 eligible patients, including 1,670 warfarin-users and 337 non-users. The mean follow-up duration was 2.1 years. The crude proportions of thromboembolic events were 3.0% and 3.0% and those of bleeding events were 0.4% and 0.3% in the warfarin and control groups, respectively. There was no significant difference in thromboembolic events between the groups (sub-distribution hazard ratio: 0.77; 95% confidence interval: 0.39–1.51; P = 0.45) or bleeding events (sub-distribution hazard ratio: 0.78; 95% confidence interval: 0.09–7.03; P = 0.83). CONCLUSIONS Warfarin use at discharge after a Fontan operation may not be necessary for thromboembolism prophylaxis in paediatric patients, based on large-scale real-world data, with a mean postoperative follow-up duration of 2.1 years. There is room for further studies to reconsider routine warfarin use in patients post-Fontan operation.

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Anticoagulation Therapy After the Fontan Procedure

Cited by 4 publications

References 13 publications

Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Real-World Use and Outcomes of Apixaban for Early Post-Surgical Fontan Thromboprophylaxis

Association between warfarin use and thromboembolic events in patients post-Fontan operation: propensity-score overlap weighting analyses

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