TY - JOUR
T1 - Thrombotic complications and thromboprophylaxis across all three stages of single ventricle heart palliation
AU - Manlhiot, Cedric
AU - Brandão, Leonardo R.
AU - Kwok, Judith
AU - Kegel, Stefan
AU - Menjak, Ines B.
AU - Carew, Caitlin L.
AU - Chan, Anthony K.
AU - Schwartz, Steven M.
AU - Sivarajan, V. Ben
AU - Caldarone, Christopher A.
AU - Van Arsdell, Glen S.
AU - McCrindle, Brian W.
N1 - Funding Information:
The authors wish to acknowledge the contribution of the following people: Kyle Millar, Veronica Chan, and Sunita Sidhu for their help with different aspects of this study. This study was funded by the Labatt Family Heart Centre Innovations Fund .
Funding Information:
Supported by the Labatt Family Heart Centre Innovations Funds and the CIBC World Markets Children's Miracle Foundation Endowed Chair in Child Health Research. The authors declare no conflicts of interest.
PY - 2012/9
Y1 - 2012/9
N2 - Objectives: To describe the incidence of thrombotic complications across all 3 stages of single ventricle palliation and the association between thromboprophylaxis use and thrombotic risk. Study design: Two separate cross-sectional studies were performed that included 195 patients born between 2003-2008 and 162 patients who underwent Fontan after 2000. Results: The incidence of thrombotic complications was 40% and 28% after initial palliation and superior cavopulmonary connection (SCPC), respectively; 5-year freedom from thrombotic complications after Fontan was 79%. Thromboprophylaxis was initiated for 70%, 46%, and 94% of patients after initial palliation, SCPC, and Fontan, respectively. Thromboprophylaxis with enoxaparin (vs no thromboprophylaxis) was associated with a reduction in risk of thrombotic complications after initial palliation (hazard ratio [HR] 0.5, P = .05) and SCPC (HR 0.2, P = .04). Thromboprophylaxis with warfarin was associated with a reduction in thrombotic complications after Fontan (HR 0.27, P = .05 vs acetylsalicylic acid; HR 0.18, P = .02 vs no thromboprophylaxis). Thrombotic complications were associated with increased mortality after initial palliation (HR 5.5, P < .001) and SCPC (HR 12.5, P < .001). Three patients experienced major bleeding complications without permanent sequelae (2 enoxaparin, 1 warfarin). Conclusions: Given the negative impact of thrombotic complications on survival, the low risk of serious bleeding complications, and the association between thromboprophylaxis and lowered thrombotic complication risk across all 3 palliative stages, routine use of thromboprophylaxis from the initial palliation to the early post-Fontan period in this population may be indicated.
AB - Objectives: To describe the incidence of thrombotic complications across all 3 stages of single ventricle palliation and the association between thromboprophylaxis use and thrombotic risk. Study design: Two separate cross-sectional studies were performed that included 195 patients born between 2003-2008 and 162 patients who underwent Fontan after 2000. Results: The incidence of thrombotic complications was 40% and 28% after initial palliation and superior cavopulmonary connection (SCPC), respectively; 5-year freedom from thrombotic complications after Fontan was 79%. Thromboprophylaxis was initiated for 70%, 46%, and 94% of patients after initial palliation, SCPC, and Fontan, respectively. Thromboprophylaxis with enoxaparin (vs no thromboprophylaxis) was associated with a reduction in risk of thrombotic complications after initial palliation (hazard ratio [HR] 0.5, P = .05) and SCPC (HR 0.2, P = .04). Thromboprophylaxis with warfarin was associated with a reduction in thrombotic complications after Fontan (HR 0.27, P = .05 vs acetylsalicylic acid; HR 0.18, P = .02 vs no thromboprophylaxis). Thrombotic complications were associated with increased mortality after initial palliation (HR 5.5, P < .001) and SCPC (HR 12.5, P < .001). Three patients experienced major bleeding complications without permanent sequelae (2 enoxaparin, 1 warfarin). Conclusions: Given the negative impact of thrombotic complications on survival, the low risk of serious bleeding complications, and the association between thromboprophylaxis and lowered thrombotic complication risk across all 3 palliative stages, routine use of thromboprophylaxis from the initial palliation to the early post-Fontan period in this population may be indicated.
UR - http://www.scopus.com/inward/record.url?scp=84865311015&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865311015&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2012.03.004
DO - 10.1016/j.jpeds.2012.03.004
M3 - Article
C2 - 22513267
AN - SCOPUS:84865311015
SN - 0022-3476
VL - 161
SP - 513-519.e3
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 3
ER -