IMEX   05356
INSTITUTO DE MEDICINA EXPERIMENTAL
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
Long-term Outcome in Children on Anticoagulant Therapy after Extracardiac Conduit Fontan Operation (FO)
Autor/es:
AGAZZONI M; CONEJEROS W; ROMERO ML; SCHLICHTER A; KREUTZER GO; VAZQUEZ H; GRIPPO M; MESCHENGIESER SS; BARRENECHEA M; PELLICCIARI R; SÁNCHEZ LUCEROS A
Lugar:
Berlin
Reunión:
Congreso; 26th Congress of ISTH & 63rd Annual Scientific and Standardization Committee (SSC) Meeting; 2017
Institución organizadora:
International Society on Thrombosis and Haemostasis
Resumen:
Background: FO is performed in children with tricuspid atresia anda variety of congenital heart defects. Several modifications have improved early and late mortality and morbidity, mostly due to thromboembolic events (TE) and arrhythmias. The incidence of thrombotic events and the event-related mortality are high, reaches 25-38%. There is no consensus about the best strategy to prevent TE.Aims: To evaluate the occurrence of TE and/or bleeding events in children prospective cohort with the same type of FO under anticoagulantprophylaxis therapy.Methods: Between August 1999 and July 2016, we conducted a prospective study to evaluate the occurrence of TE and bleeding eventsin 114 children (mean age 7.6 years, range 2-21; 60.5% boys) who underwenta modified FO (Fontan-Kreutzer) palliative procedure usinga cavopulmonary connection with extracardiac PTFE conduit or none prosthesis. Acenocoumarol was initiated (INR target: 2.0-3.0) immediately after withdrawal of chest tube drainage (mean 6.4 ± 3.8 days,range 2-25). Quality of anticoagulation monitoring was evaluated with Rosendaal´s program. All parents signed informed consent. The protocol was approved by Institutional Ethical Committee.Results: The total follow-up time was 982 years (mean 8.6 years).Eleven patients were lost to follow-up (mean 34 months, range6-72). Patients remained in the desired INR range 67.7% of the time, 14% above (>3) and 18.3% below (< 2). At last follow-up, 23 patients had reached adulthood (mean age of 25.6 years, range 22-35). TE and bleeding events are described in table: 2/3 patientspresented TE events (one dying) associated to interruption of acenocoumaroldue to pneumonia; the third had had poor treatment compliance. Conclusions: Primary prophylaxis with oral anticoagulation, initiated rapidly after modified FO surgery could be considered a a safe and effective therapy in children. Studies on bridging strategies in these patients are necessary in order to limit the morbi-mortality associated.