TY - JOUR
T1 - Thromboprophylaxis for atrial arrhythmias in congenital heart disease
T2 - A multicenter study
AU - Khairy, Paul
AU - Aboulhosn, Jamil
AU - Broberg, Craig S.
AU - Cohen, Scott
AU - Cook, Stephen
AU - Dore, Annie
AU - Fernandes, Susan M.
AU - Fournier, Anne
AU - Kay, Joseph
AU - Levesque, Sylvie
AU - Macle, Laurent
AU - Marcotte, François
AU - Mondésert, Blandine
AU - Mongeon, François Pierre
AU - Opotowsky, Alexander R.
AU - Proietti, Anna
AU - Rivard, Lena
AU - Ting, Jennifer
AU - Thibault, Bernard
AU - Zaidi, Ali
AU - Hamilton, Robert
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/11/15
Y1 - 2016/11/15
N2 - Background There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease. Methods A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. Results A total of 482 patients, 45.2% female, age 32.0 ± 18.0 years, were followed for 11.3 ± 9.4 years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital heart disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7 ± 2.7% at 15 years, with no difference between anticoagulation versus antiplatelet therapy (P = 0.97). Congenital heart disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P < 0.001). CHADS2 and CHA2DS2-VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P = 0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05–21.58), P = 0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P = 0.047] were independently associated with major bleeds. Conclusion Current management of atrial arrhythmias in congenital heart disease is associated with a modest rate of thromboembolic events, which is predicted by disease complexity but not CHADS2/CHA2DS2-VASc scores. HAS-BLED score is applicable to the congenital population in predicting major bleeds.
AB - Background There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease. Methods A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. Results A total of 482 patients, 45.2% female, age 32.0 ± 18.0 years, were followed for 11.3 ± 9.4 years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital heart disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7 ± 2.7% at 15 years, with no difference between anticoagulation versus antiplatelet therapy (P = 0.97). Congenital heart disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P < 0.001). CHADS2 and CHA2DS2-VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P = 0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05–21.58), P = 0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P = 0.047] were independently associated with major bleeds. Conclusion Current management of atrial arrhythmias in congenital heart disease is associated with a modest rate of thromboembolic events, which is predicted by disease complexity but not CHADS2/CHA2DS2-VASc scores. HAS-BLED score is applicable to the congenital population in predicting major bleeds.
KW - Anticoagulation
KW - Antiplatelet therapy
KW - Atrial tachycardia
KW - Bleeding
KW - Congenital heart disease
KW - Thromboembolic event
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U2 - 10.1016/j.ijcard.2016.08.223
DO - 10.1016/j.ijcard.2016.08.223
M3 - Article
C2 - 27573597
AN - SCOPUS:84983685306
SN - 0167-5273
VL - 223
SP - 729
EP - 735
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -