Marrone Chiara, Galasso Gennaro, Piccolo Raffaele, de Leva Francesco, Paladini Rodolfo, Piscione Federico, Santoro Giuseppe
Pediatric Cardiology Unit, Santobono-Pausilipon Hospital, Via M. Fiore 6, Naples, Italy.
Pediatr Cardiol. 2011 Jan;32(1):32-9. doi: 10.1007/s00246-010-9808-4. Epub 2010 Oct 22.
The benefits of prophylactic anticoagulation or antiplatelet therapy for patients undergoing extracardiac conduit (ECC) Fontan procedure still are a matter of debate. Through a systematic review and meta-analysis, this study aimed to determine the incidence of thromboembolism among patients undergoing ECC Fontan who received anticoagulation or antiplatelet therapy. Until February 2010, MEDLINE studies describing the incidence of thromboembolic events after ECC Fontan were reviewed. Information on type of drugs and clinical outcome was extracted. The 20 studies analyzed involved 1,075 patients: 220 (20.4%) in the antiplatelet group and 855 (79.5%) in the anticoagulation group. The mean follow-up period ranged from 2 to 144 months. The overall thromboembolism rate was 5.2% (95% confidence interval [CI], 3.8-7%; I(2) = 0%; p(het) = 0.32). The effect of different therapeutic strategies on the occurrence of thromboembolic and bleeding events was analyzed. Interestingly, the anticoagulation therapy compared with the antiplatelet therapy was not associated with a significant reduction in the incidence of overall thromboembolic complications (5% vs 4.5%, respectively; I(2) = 0%; p(het) = 0.80). Only two cases of bleeding were observed among patients receiving anticoagulant therapy at the time of the event. For patients undergoing ECC Fontan, the rate of thromboembolic and bleeding events associated with antiplatelet therapy is similar to that associated with anticoagulation therapy.
对于接受心外管道（ECC）Fontan手术的患者，预防性抗凝或抗血小板治疗的益处仍存在争议。通过系统评价和荟萃分析，本研究旨在确定接受抗凝或抗血小板治疗的ECC Fontan患者中血栓栓塞的发生率。截至2010年2月，对描述ECC Fontan术后血栓栓塞事件发生率的MEDLINE研究进行了综述。提取了有关药物类型和临床结局的信息。分析的20项研究涉及1075例患者：抗血小板组220例（20.4%），抗凝组855例（79.5%）。平均随访期为2至144个月。总体血栓栓塞率为5.2%（95%置信区间[CI]，3.8 - 7%；I(2)=0%；p(het)=0.32）。分析了不同治疗策略对血栓栓塞和出血事件发生的影响。有趣的是，与抗血小板治疗相比，抗凝治疗与总体血栓栓塞并发症发生率的显著降低无关（分别为5%和4.5%；I(2)=0%；p(het)=0.80）。在事件发生时接受抗凝治疗的患者中仅观察到2例出血病例。对于接受ECC Fontan手术的患者，与抗血小板治疗相关的血栓栓塞和出血事件发生率与抗凝治疗相似。
