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Rate and risk factors for thromboembolism and major bleeding in adults with congenital heart disease taking vitamin K antagonist therapy

Samarai, Daniel LU orcid ; Lindstedt, Sandra LU ; Isma, Nazim LU and Hlebowicz, Joanna LU (2022) In Thrombosis Update 9.
Abstract

Background: The risk of adults with a congenital heart defect (ACHD) developing heart failure, stroke, arrhythmias, and the need for valve replacement is increased compared to healthy peers. Evidence for the use of novel oral anticoagulants (NOAC) in this patient group is still lacking and vitamin K antagonists (VKA) are the primary choice for patients with a mechanical valve. The present aim was to determine the rate of thromboembolic and major bleeding events in ACHD patients on VKA therapy. Methods: This was a retrospective study on ACHD patients on VKA treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. Results: 213... (More)

Background: The risk of adults with a congenital heart defect (ACHD) developing heart failure, stroke, arrhythmias, and the need for valve replacement is increased compared to healthy peers. Evidence for the use of novel oral anticoagulants (NOAC) in this patient group is still lacking and vitamin K antagonists (VKA) are the primary choice for patients with a mechanical valve. The present aim was to determine the rate of thromboembolic and major bleeding events in ACHD patients on VKA therapy. Methods: This was a retrospective study on ACHD patients on VKA treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. Results: 213 patients were included with a mean age of 50 years (±18) years and a mean follow-up of 6.6 years (±3.3 years), 16% had complex defects and 41% had valvular VKA therapy indication. In total, 34 complications were registered, of which 14 were thromboembolic events and 20 were major bleeding events. The rate of thromboembolism and major bleeding events was 1.0 (95% CI: 0.6–1.6) and 1.4 (95% CI: 0.9–2.2) per 100 patient-years, respectively. Forty-three patients died during the study period. The mortality rate was 3.1 per 100 patient-years (95% CI: 2.2–4.1). Conclusion: We found a low rate of thromboembolic events and major bleeding events for low-moderate risk ACHD patients with good quality of VKA anticoagulation. The target of TTR>65% for ACHD patients is recommended.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult congenital heart disease, Anticoagulant therapy, International normalized ratio, Oral vitamin K antagonists, Time in therapeutic range
in
Thrombosis Update
volume
9
article number
100122
publisher
Elsevier
external identifiers
  • scopus:85137670467
DOI
10.1016/j.tru.2022.100122
language
English
LU publication?
yes
id
71047a66-6718-4b2c-b2f5-d3b8db5b6155
date added to LUP
2022-11-30 11:01:30
date last changed
2023-05-15 10:37:56
@article{71047a66-6718-4b2c-b2f5-d3b8db5b6155,
  abstract     = {{<p>Background: The risk of adults with a congenital heart defect (ACHD) developing heart failure, stroke, arrhythmias, and the need for valve replacement is increased compared to healthy peers. Evidence for the use of novel oral anticoagulants (NOAC) in this patient group is still lacking and vitamin K antagonists (VKA) are the primary choice for patients with a mechanical valve. The present aim was to determine the rate of thromboembolic and major bleeding events in ACHD patients on VKA therapy. Methods: This was a retrospective study on ACHD patients on VKA treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. Results: 213 patients were included with a mean age of 50 years (±18) years and a mean follow-up of 6.6 years (±3.3 years), 16% had complex defects and 41% had valvular VKA therapy indication. In total, 34 complications were registered, of which 14 were thromboembolic events and 20 were major bleeding events. The rate of thromboembolism and major bleeding events was 1.0 (95% CI: 0.6–1.6) and 1.4 (95% CI: 0.9–2.2) per 100 patient-years, respectively. Forty-three patients died during the study period. The mortality rate was 3.1 per 100 patient-years (95% CI: 2.2–4.1). Conclusion: We found a low rate of thromboembolic events and major bleeding events for low-moderate risk ACHD patients with good quality of VKA anticoagulation. The target of TTR&gt;65% for ACHD patients is recommended.</p>}},
  author       = {{Samarai, Daniel and Lindstedt, Sandra and Isma, Nazim and Hlebowicz, Joanna}},
  keywords     = {{Adult congenital heart disease; Anticoagulant therapy; International normalized ratio; Oral vitamin K antagonists; Time in therapeutic range}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Thrombosis Update}},
  title        = {{Rate and risk factors for thromboembolism and major bleeding in adults with congenital heart disease taking vitamin K antagonist therapy}},
  url          = {{http://dx.doi.org/10.1016/j.tru.2022.100122}},
  doi          = {{10.1016/j.tru.2022.100122}},
  volume       = {{9}},
  year         = {{2022}},
}