Anticoagulation cuts TEC rate in adults after fontan surgery

(HealthDay)—For adults with atrial arrhythmia after Fontan operation, the risk of thrombotic and embolic complications (TEC) is reduced with anticoagulation therapy, according to research published in the Sept. 20 issue of the Journal of the American College of Cardiology.

Alexander C. Egbe, M.D., M.P.H., from the Mayo Clinic in Rochester, Minn., and colleagues conducted a retrospective review of 278 adults with atrial arrhythmia after Fontan operation. Patients were followed for 88 ± 14 months. Patients were divided into anticoagulation (91 patients), antiplatelet (181 patients), and no therapy (six patients) cohorts.

The researchers found that there were 97 TEC in 81 patients (29 percent), of which 32 and 65 were systemic and nonsystemic, respectively, yielding an event rate of 2.1 and 4.4 systemic and nonsystemic TEC per 100 patient-years, respectively. At five and 10 years, the prevalence of TEC was 18 and 55 percent, respectively. Atriopulmonary connection was identified as a risk factor for TEC (hazard ratio, 2.31), and TEC correlated with elevated risk of death and hospitalization (P < 0.0001). Anticoagulation was protective against TEC and correlated with a reduction in the risk of TEC by 2.5 TEC per 100 patient-years. Anticoagulation also correlated with reduced risk of death and hospitalization (P = 0.02). In 7 percent of patients bleeding complications occurred, with similar rates in all groups.

"Anticoagulation was associated with lower TEC rate and lower risk of death and hospitalization, without a significant increase in bleeding risk," the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical device industries.

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