Key result
NOACs may be considered as an alternative to vitamin K antagonists for selected adult patients with congenital heart disease, though treatment decisions must be individualized based on specific pathophysiology.
Why the study?
Thromboembolic events are a common cause of death in adults with CHD requiring long-term anticoagulation, prompting the need to assess the efficacy and safety of NOACs in this population.
Are non-vitamin K antagonist oral anticoagulants (NOACs) safe and effective compared to vitamin K antagonists for thromboprophylaxis in adults with congenital heart disease?
Are non-vitamin K antagonist oral anticoagulants (NOACs) safe and effective compared to vitamin K antagonists for thromboprophylaxis in adults with congenital heart disease?
NOACs represent a promising, guideline-supported alternative to VKAs for thromboprophylaxis in adults with congenital heart disease, offering reduced bleeding risk and monitoring burden.
NOACs may be feasible for thromboembolic prevention in select adult CHD patients; leaves open need for RCTs to guide practice.
Despite an improved survival rate, cardiovascular accidents including thromboembolic events are a common cause of death in adults with congenital heart disease (CHD). Therefore, many adult patients with CHD require long-term oral anticoagulants depending on disease complexity, atrial tachyarrhythmia, residual intracardiac shunt, ventricular dysfunction, and the presence of a prosthetic valve. Although prevention of stroke and pulmonary embolism has traditionally been managed with vitamin K antagonists (VKA), recent guidelines suggest the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with adult CHD presenting with atrial fibrillation (AF), stroke, or pulmonary embolism. NOACs are an efficient alternative to VKA with reduced bleeding propensity, relatively low dietary and drug interactions, and the potential to eliminate the need for international normalized ratio monitoring in patients with nonvalvular AF. Recently, several multicenter studies reported the indication for thromboprophylaxis and the potential role of NOACs in adult CHD patients. In this review, we aim to assess the efficacy and safety of NOACs in adult CHD patients and to pursue adequate anticoagulation strategies in this special population.
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Ji‐Eun Ban (2022) conducted a review in Adult congenital heart disease (CHD). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKA) was evaluated. NOACs may be considered as an alternative to vitamin K antagonists for selected adult patients with congenital heart disease, though treatment decisions must be individualized based on specific pathophysiology.
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