title: Thrombotic complications and thromboprophylaxis across all three stages of single ventricle heart palliation.
abstract: OBJECTIVE
  To describe the incidence of thrombotic complications across all 3 stages of single ventricle palliation and the association between thromboprophylaxis use and thrombotic risk.
  
  
  METHODS
  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.
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
authors.forename: Judith
authors.initials: J
authors.lastname: Kwok
authors.forename: Stefan
authors.initials: S
authors.lastname: Kegel
authors.forename: Ines B
authors.initials: IB
authors.lastname: Menjak
authors.forename: Caitlin L
authors.initials: CL
authors.lastname: Carew
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Chan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000517:prevention & control; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin