Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease

Mongeon, François‐Pierre; Macle, Laurent; Beauchesne, Luc; Bouma, Berto J.; Schwerzmann, Markus; Mulder, Barbara J.M.; Khairy, Paul

doi:10.1016/j.cjca.2019.06.022

Cited by 22 publications

(14 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Given the scarce data on safety and efficacy of new oral anticoagulants as well as suggestions of a potential harmful effect (26), these drugs should be used very restrictively (if at all) in this population (26,27).…”

Section: Thrombotic and Embolic Complicationsmentioning

confidence: 99%

Treatment of adults with Eisenmenger syndrome—state of the art in the 21st century: a short overview

Diller

Lammers

Oechslin

2021

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

Eisenmenger syndrome (ES) develops in association with unrepaired, non-restrictive cardiac shunt lesions at the atrial, ventricular or arterial level over time. In developed countries, cardiac defects are being operated on in a timely manner, before pulmonary vascular disease develops. However, with rising immigration from underserved countries, we increasingly see patients with shunt lesions, that are not amenable for repair as pulmonary vascular disease has already established. ES describes a symptom complex and patients present with heterogeneous problems involving many organ systems (multisystem disorder).Care in tertiary specialist cardiac centers with access to multidisciplinary subspecialities is required. Central cyanosis with secondary erythrocytosis is one of the key features of patients with ES. Clinical consequences of longstanding hypoxia can lead to other organ complications, that involve other organs than the heart alone. Although ES patients have a better prognosis compared to other patients with pulmonary arterial hypertension, ES grossly affects quality of life and morbidity is frequent. Follow-up and care at specialist congenital heart disease centers is highly recommended to prevent, to early diagnose and to timely manage complications of ES. This is necessary to maintain functional capacity, decrease morbidity and increase life expectancy for these vulnerable patients. The leading reasons for mortality are sudden cardiac death, progressive heart failure, and infectious diseases. Various factors have been shown to be associated with mortality like decreased arterial oxygen saturation, functional class, impaired exercise tolerance, syncopal events, iron deficiency, presence of pre-tricuspid shunts, arrhythmias, increased (NT-pro) brain natriuretic peptide, echocardiographic variables of right ventricular dysfunction and hospitalization for heart failure.Although to date there is no causal therapy to reverse pulmonary vascular disease, a greater armamentarium of targeted therapies is available, which have been shown to be beneficial in patients with ES.

show abstract

Section: Thrombotic and Embolic Complicationsmentioning

confidence: 99%

Treatment of adults with Eisenmenger syndrome—state of the art in the 21st century: a short overview

Diller

Lammers

Oechslin

2021

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

show abstract

“…Therefore, the current guidelines most commonly endorse the use of VKA in ACHD patients (1,14). However, the current status regarding the use of NOACs has to be reassessed in light of new study results and publications specifically addressing this issue in ACHD patients (1,14,16,(21)(22)(23)(27)(28)(29)(30)(31)(32)(33)(34). The current recommendations as covered by the guidelines summarized in Figure 2.…”

Section: The Use Of Novel Oral Anticoagulants (Noac) In Achd Patientsmentioning

confidence: 99%

“…The use of NOACs in Fontan was assessed only in one additional study (16) of 21 Fontan patients as well reporting low numbers of bleeding events or thrombosis. However, there are some reports in the literature on clotting in Fontan Patients on NOACS (29,39,40) Moreover, randomized trials, long-term outcome studies and research into often associated pre-existing abnormalities in clotting and fibrinolysis (41,42) which make the use of NOAC more challenging are largely missing in such patients. Even in the largest study of patients with Fontan surgery, the NOTE registry (22), only 74 Fontan patients were included.…”

Section: The Use Of Novel Oral Anticoagulants (Noac) In Achd Patientsmentioning

confidence: 99%

“…The prevalence of AF is rapidly increasing in the aging population with ACHD, and is associated with considerable morbidity. In ACHD patients AF is already the leading presenting arrhythmia over the age of 50 (14,29,43). While NOACs can be prescribed in patients with simple defects (1) their use may also be considered in moderate or complex ACHD patients (22,23).…”

Section: The Use Of Novel Oral Anticoagulants (Noac) In Achd Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Anticoagulation management in adult patients with congenital heart disease: a narrative review

Sinning¹,

Zengin²,

Blankenberg³

et al. 2021

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

With improvements in treatment of congenital heart disease more paediatric patients are surviving with palliative or corrective interventions during childhood, thus becoming adults with congenital heart disease (ACHD). Overall, the ACHD population is at a higher risk of arrhythmias and stroke. The abnormal structure and function of their corrected hearts suggests that in addition to established stroke risk factors, such as prior stroke or older age, additional stroke risk factors need to be considered to determine the risk and establish the indication for oral anticoagulation (OAC) in ACHD patients. In structurally normal hearts non-vitamin-K oral anticoagulants (NOACs) offer at least equal stroke prevention with a better safety profile compared to vitamin K antagonists (VKA) in patients with atrial fibrillation (AF) or pulmonary embolism. Current guidelines recommend NOACs in ACHD patients with simple lesions and indication for OAC, while there is less certainty about their safety in ACHD patients with moderate or complex congenital heart disease such as patients with transposition of the great arteries (TGA) after atrial switch operation (Senning or Mustard operation), Fontan circulation or congenital corrected transposition of the great arteries (ccTGA). This review summarises the available evidence characterising stroke risk in patients with ACHD and the use of anticoagulants and interventional therapies to reduce that risk.

show abstract

“…Although much larger and more trustworthy than previous registries that did not observe worse outcomes in ACHD patients treated with NOACs, this retrospective analysis is not a randomized controlled study. 4 Even when statistical analyses adjust for confounding factors with propensity score matching or in a multivariable model, no registry can fully exclude selection bias. The reasons why physicians opt for NOACs or VKAs in this challenging group of patients cannot be fully controlled for, even with sophisticated statistical analyses.…”

Section: True or Biased Observations?mentioning

confidence: 99%

Non-vitamin K oral anticoagulants in adults with congenital heart disease: quod non?

Verhamme

Budts

Werf

2020

European Heart Journal

View full text Add to dashboard Cite

Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease

Cited by 22 publications

References 82 publications

Treatment of adults with Eisenmenger syndrome—state of the art in the 21st century: a short overview

Treatment of adults with Eisenmenger syndrome—state of the art in the 21st century: a short overview

Anticoagulation management in adult patients with congenital heart disease: a narrative review

Non-vitamin K oral anticoagulants in adults with congenital heart disease: quod non?

Contact Info

Product

Resources

About