Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND/OBJECTIVES: Pregnancy may potentiate the inherent hypercoagulability of the Fontan circulation, thereby amplifying adverse events. This study sought to evaluate thrombosis and bleeding risk in pregnant women with a Fontan. METHODS: We performed a retrospective observational cohort study across 13 international centres and recorded data on thrombotic and bleeding events, antithrombotic therapies and pre-pregnancy thrombotic risk factors. RESULTS: We analysed 84 women with Fontan physiology undergoing 108 pregnancies, average gestation 33±5 weeks. The most common antithrombotic therapy in pregnancy was aspirin (ASA, 47 pregnancies (43.5%)). Heparin (unfractionated (UFH) or low molecular weight (LMWH)) was prescribed in 32 pregnancies (30%) and vitamin K antagonist (VKA) in 10 pregnancies (9%). Three pregnancies were complicated by thrombotic events (2.8%). Thirty-eight pregnancies (35%) were complicated by bleeding, of which 5 (13%) were severe. Most bleeds were obstetric, occurring antepartum (45%) and postpartum (42%). The use of therapeutic heparin (OR 15.6, 95% CI 1.88 to 129, p=0.006), VKA (OR 11.7, 95% CI 1.06 to 130, p=0.032) or any combination of anticoagulation medication (OR 13.0, 95% CI 1.13 to 150, p=0.032) were significantly associated with bleeding events, while ASA (OR 5.41, 95% CI 0.73 to 40.4, p=0.067) and prophylactic heparin were not (OR 4.68, 95% CI 0.488 to 44.9, p=0.096). CONCLUSIONS: Current antithrombotic strategies appear effective at attenuating thrombotic risk in pregnant women with a Fontan. However, this comes with high (>30%) bleeding risk, of which 13% are life threatening. Achieving haemostatic balance is challenging in pregnant women with a Fontan, necessitating individualised risk-adjusted counselling and therapeutic approaches that are monitored during the course of pregnancy.
Source: Heart
Authors: Andrea Girnius, Dominica Zentner, Anne Marie Valente, Petronella G Pieper, Katherine E Economy, Magalie Ladouceur, Jolien W Roos-Hesselink, Carri Warshak, Sara L Partington, Zhiqian Gao, Nicholas Ollberding, Michelle Faust, Saulius Girnius, Harald Kaemmerer, Nicole Nagdyman, Scott Cohen, Mary Canobbio, Teiji Akagi, Jasmine Grewal, Elisa Bradley, Yonathan Buber, Joseph Palumbo, Niki Walker, Jamil Aboulhosn, Erwin Oechslin, Helmut Baumgartner, Wesam Kurdi, Wendy M Book, Barbara J M Mulder, Gruschen R Veldtman
Institutions: University of Cincinnati, The Royal Melbourne Hospital, The University of Melbourne, Brigham and Women's Hospital, Harvard University, University Medical Center Groningen, Hôpital Necker-Enfants Malades, Hôpital Européen Georges-Pompidou, Erasmus MC, Children's Hospital of Philadelphia, Hospital of the University of Pennsylvania, Cincinnati Children's Hospital Medical Center, TriHealth, Deutsches Herzzentrum München, Medical College of Wisconsin, University of California, Los Angeles, Okayama University, University of British Columbia, Nationwide Children's Hospital, The Ohio State University, University of Washington, University Health Network, University of Toronto, Toronto General Hospital, University Hospital Münster, King Faisal Specialist Hospital & Research Centre, Emory University, Amsterdam UMC Location University of Amsterdam
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W3109948567