The following is a summary of “Thromboprophylaxis in Patients With Fontan Circulation,” published in the 2023 January issue of Cardiology by Eynde, et al.
Patients with Fontan circulation may benefit from thromboprophylaxis, but the best approach is uncertain. For a study, researchers sought to compare the effectiveness and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs).
Included was pertinent research that has been released by February 2022. Thromboembolic events were the main success indicator, whereas severe bleeding was the main failure indicator. Frequentist network meta-analyses were performed to calculate the incidence rate ratios (IRRs) of both outcomes. Finally, treatments were ranked according to their probability (P) scores.
There were 21 studies listed in all (26,546 patient-years). NOAC, warfarin, and aspirin were all linked to significantly decreased risks of thromboembolic events when compared to no thromboprophylaxis (IRR: 0.11; 95% CI: 0.03-0.40), as well as warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39). However, the network meta-analysis did not find any changes in the incidence of serious bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). According to rankings that evaluated competing therapies simultaneously, NOACs had the greatest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). The most advantageous overall profile was frequently aspirin.
The use of aspirin, warfarin, and NOAC was linked to a decreased risk of thromboembolic events. The findings indicated the safety and effectiveness of NOACs in patients with Fontan circulation, despite the small patient population and variability of trials utilizing these medications.
Reference: jacc.org/doi/10.1016/j.jacc.2022.10.037