Journal of Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2433-1783 Print ISSN: 2433-2720
Japanese Society of Pediatric Cardiology and Cardiac Surgery
Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of Pediatric Cardiology and Cardiac Surgery 1(1): 70-78 (2017)

Original ArticleOriginal Article

Thrombotic or Bleeding Complications in Patients Undergoing the Fontan Procedure and Receiving Prophylactic Anticoagulation and/or Antiplatelet Therapy

Department of Pediatrics, National Hospital Organization Kagoshima Medical Center ◇ Kagoshima, Japan

受付日:2017年5月29日Received: May 29, 2017
受理日:2017年6月13日Accepted: June 13, 2017
発行日:2017年7月1日Published: July 1, 2017

Background: Although many patients undergoing the Fontan procedure require anticoagulants or antiplatelet drugs, there is no consensus regarding thromboprophylaxis after this procedure.

Methods: To clarify the incidence of thrombotic or bleeding complications and their characteristics, we retrospectively studied 49 patients (34 male and 15 female) who underwent the Fontan procedure between 1989 and 2012. Their average age was 16.3±7.7 years, the average age at which total cavopulmonary connection surgery was performed was 4.5±3.7 years, and the mean duration of postoperative observation was 59.1±45 months.

Results: All patients received warfarin and all but one received aspirin. Three patients developed cerebral infarction, one of whom also developed renal infarction. With prompt treatment, all three patients recovered without sequelae. With regard to bleeding complications, one of three patients who developed pulmonary hemorrhage died. Gastrointestinal bleeding occurred on six occasions in three patients, only one of whom had associated abdominal pain. Urgent blood transfusions were necessary on five of these occasions. Additionally, subcutaneous hemorrhage, macrohematuria, ovarian hemorrhage, and polyhypermenorrhea also occurred. In patients with bleeding complications, the mean prothrombin time/international normalized ratio was 1.9±0.5. These hemorrhagic events were managed by the discontinuation of aspirin and reduction of the warfarin dosage.

Conclusion: It is necessary to determine whether a combination of aspirin and warfarin is indicated for maintaining adequate circulation after the Fontan procedure. Because combination treatments are likely to cause more bleeding complications, the use of individual drugs should be investigated.

Key words: Fontan; thromboprophylaxis; anticoagulation; antiplatelet; bleeding ulcer

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