The Use of Novel Oral Anticoagulants in Adult Congenital Heart Disease: A Single Center Experience

Novel oral anticoagulant use in adult Fontan patients: A single center experience

“…However, the experience with NOACs in patients with congenital heart disease is limited, particularly in adult Fontan patients . Recognizing this, the 2014 PACES/HRS Expert Consensus Statement guidelines made a Class III, Level of Evidence C, recommendation against the use of NOACs in adult Fontan patients due in part to the lack of safety, efficacy, pharmacokinetic, and pharmacodynamic data, along with concerns regarding abnormal Fontan coagulation …”

“…15 However, the experience with NOACs in patients with congenital heart disease is limited, particularly in adult Fontan patients. [16][17][18][19][20][21] Recognizing this, the 2014 PACES/HRS Expert Consensus Statement guidelines made a Class III, Level of Evidence C, recommendation against the use of NOACs in adult Fontan patients due in part to the lack of safety, efficacy, pharmacokinetic, and pharmacodynamic data, along with concerns regarding abnormal Fontan coagulation. 2,22,23 While not well studied in adult Fontan patients specifically, the pharmacokinetic and pharmacodynamics properties of NOACs have been well established in the tens of thousands of patients who received them during clinical trials and even greater numbers since they have become popularized after gaining American and European guideline approval.…”

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

“…These findings were considered reassuring, particularly in patients with moderate or complex CHD 13 . Cheng et al reported 13 patients with CHD treated with a NOAC for a median 570 days 9 . More gastrointestinal side effects were observed with CI 0.39-0.59, p<0.0001) 6 .…”

“…There is no substitute for clinical research in assessing the value of NOACs in the adult CHD population. Ongoing studies, such as the multinational NOACs for atrial tachyarrhythmias in congenital heart disease (NOTE) registry (www.clinicaltrials.gov NCT02928133), have begun providing reassuring short-term safety data and will no doubt shed light on longer-term outcomes in the future [9][10][11][12][13] . In the interim, a review of present knowledge could help inform current practice regarding subgroups of adults with CHD for whom it may be reasonable to prescribe a NOAC when anticoagulation is indicated.…”

Thrombotic and Thromboembolic Complications in Patients with Adult Congenital Heart Disease

“…However, choice of treatment varies across institutions with anticoagulation and aspirin both frequently used. While warfarin is the most frequently employed anticoagulant there is emerging data regarding the use of non-vitamin K oral anticoagulants in the adult Fontan patients [19,20]. Randomized trials are necessary to determine both the choice of agent and the appropriate timing of anticoagulation.…”