title: Comparative trial of the use of antiplatelet and oral anticoagulant in thrombosis prophylaxis in patients undergoing total cavopulmonary operation with extracardiac conduit: echocardiographic, tomographic, scintigraphic, clinical and laboratory analysis.
abstract: OBJECTIVE
  To compare the efficacy of aspirin and warfarin for prophylaxis of thrombosis in patients undergoing total cavopulmonary anastomosis. Evaluate whether coagulation factors (VII, VIII and protein C), clinical data, fenestration or hemodynamic factors, interfere with postoperative thrombosis.
  
  
  METHODS
  A prospective, randomized study of 30 patients, randomized into Group I (Warfarin) and Group II (AAS), underwent total cavopulmonary shunt with extracardiac conduit, between 2008 and 2011, with follow-up by clinical visits to evaluate side effects and adhesion. Performed transesophageal echocardiography in post operatory time, 3, 6,12 and 24 months; angiotomography at 6, 12 and 24 months to evaluate changes in the internal tube wall or thrombi and pulmonary scintigraphy to evaluate possible PTE.
  
  
  RESULTS
  Two deaths in group I; 33.3% of patients had thrombus (46.7% in Group II). The previous occurrence of thrombus and low levels of coagulation protein C were the only factors that influenced the time free of thrombus (P=0.035 and 0.047). Angiotomographic evaluation: 35.7% in group II presented material accumulation greater than 2 mm (P=0.082). Scintigraphy: two patients had PTE in group II. Five patients had difficulty to comply with the treatment, 4 in group I with INR ranging from 1 to 6.4.
  
  
  CONCLUSIONS
  The previous occurrence of thrombus is a risk factor for thrombosis in the postoperative period. Patients using AAS tend to deposit material in the tube wall. The small sample size did not allow to conclude which is the most effective drug in the prevention of thrombosis in this population.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Cristiane Felix Ximenes
authors.initials: CF
authors.lastname: Pessotti
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo Biscegli
authors.initials: MB
authors.lastname: Jatene
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Ieda Biscegli
authors.initials: IB
authors.lastname: Jatene
authors.affiliation: Hospital do Coração, ASS, São Paulo, SP, Brasil.
authors.forename: Patrícia Marques
authors.initials: PM
authors.lastname: Oliveira
authors.affiliation: Hospital do Coração, ASS, São Paulo, SP, Brasil.
authors.forename: Fabiana Moreira Passos
authors.initials: FM
authors.lastname: Succi
authors.affiliation: Hospital do Coração, ASS, São Paulo, SP, Brasil.
authors.forename: Valeria de Melo
authors.initials: Vde M
authors.lastname: Moreira
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Rafael Willain
authors.initials: RW
authors.lastname: Lopes
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Simone Rolim Fernandes Fontes
authors.initials: SR
authors.lastname: Pedra
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control; D011877:Radionuclide Imaging; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000503:physiopathology; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin