Why the study?
Patients with a Fontan circulation face an increased risk of thromboembolic events, yet controversies persist regarding risk factors and detection, and no consensus exists regarding optimal antithrombotic therapy.
This review synthesizes available literature on antithrombotic therapy in Fontan patients and proposes a practical decision-tree algorithm for thromboprophylaxis.
No consensus on antithrombotic therapy in Fontan patients precludes standardized recommendations; leaves open optimal strategies pending dedicated trials.
Patients with a Fontan circulation for single-ventricle physiology are at increased risk of developing thromboembolic events. Thromboembolic events can lead to failure of the Fontan circulation, chronic sequelae in case of stroke, and early mortality. Controversies exist regarding the substrates, risk factors, and optimal detection methods for thromboembolic events. Despite the major clinical implications, there is currently no consensus regarding the optimal antithrombotic therapy to prevent or treat thromboembolic events after the Fontan procedure. In this review we aimed to untangle the available literature regarding antithrombotic prophylaxis and treatment for pediatric and adult Fontan patients. A decision-tree algorithm for thromboprophylaxis in Fontan patients is proposed. Additionally, the current state of knowledge is reviewed with respect to the epidemiology, pathophysiology, and detection of thromboembolic events in Fontan patients, and important evidence gaps are highlighted.
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Heidendael et al. (2022) studied this question.
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