Division of Pediatric Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York.
Division of Pediatric Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York.
Semin Thorac Cardiovasc Surg. 2021 Autumn;33(3):806-813. doi: 10.1053/j.semtcvs.2020.12.008. Epub 2021 Jan 12.
Fontan circuit thrombosis is a significant cause of early postoperative morbidity and mortality. Thrombosis incidence and relationship to thromboprophylaxis choice and timing of initiation are not well established. We sought to evaluate the incidence of Fontan circuit thrombosis in the first 30 postoperative days and its relationship to thromboprophylaxis choice and timing. Patients undergoing Fontan surgery, 2006-2016, were reviewed. Fontan circuit thrombosis was defined by sonographic detection of intracardiac or deep venous thrombi. Logistic regression was used to assess relationships between thromboprophylaxis characteristics and thrombosis. One hundred ninety-two patients underwent Fontan. Fontan thrombosis occurred in 19 (10%) patients. 54% were started on aspirin, 27% coumadin, 4% heparin, and 7% none. There was no relationship between thrombosis and baseline anatomy, Fontan type or fenestration. Median time to thromboprophylaxis initiation was 4 days (interquartile range 2-6). Patients not started on thromboprophylaxis had 44.8 times the odds of thrombosis as those on thromboprophylaxis (confidence interval 6.4-311.7, P < 0.01); no children starting thromboprophylaxis before postoperative day 2 developed thromboses. For every day that thromboprophylaxis was delayed, odds of thrombosis increased by 30% (odds ratio 1.3; CI 1.1-1.6, P < 0.01). There was no difference in the odds of thrombosis between children taking aspirin vs other thromboprophylaxis types. Odds of early postoperative Fontan circuit thrombosis are increased in patients in whom thromboprophylaxis is delayed beyond the second postoperative day, with no difference in the odds of thrombosis between patients initiated on aspirin vs other thromboprophylaxis. Early aspirin institution post Fontan is recommended to reduce morbidity. Ultra-mini-Abstract: Odds of early postoperative Fontan circuit thrombosis are increased in patients in whom thromboprophylaxis is delayed beyond the second postoperative day, with no difference in the odds of thrombosis between patients initiated on aspirin vs other thromboprophylaxis. Early aspirin institution post Fontan is recommended to reduce morbidity and resource utilization.
Fontan 环血栓形成是术后早期发病率和死亡率的重要原因。血栓形成的发生率以及与血栓预防选择和开始时间的关系尚未得到很好的确定。我们旨在评估术后 30 天内 Fontan 环血栓形成的发生率及其与血栓预防选择和开始时间的关系。回顾了 2006 年至 2016 年间接受 Fontan 手术的患者。通过超声检测心内或深静脉血栓形成来定义 Fontan 环血栓形成。使用逻辑回归评估血栓形成与血栓预防特征之间的关系。192 例患者接受了 Fontan 手术。19 例（10%）患者发生了 Fontan 血栓形成。54%的患者开始服用阿司匹林，27%的患者服用华法林，4%的患者服用肝素，7%的患者未服用任何药物。血栓形成与基线解剖结构、Fontan 类型或开窗无关。开始血栓预防治疗的中位时间为 4 天（四分位距 2-6）。未开始血栓预防治疗的患者发生血栓形成的可能性是开始血栓预防治疗患者的 44.8 倍（置信区间 6.4-311.7，P < 0.01）；术后第 2 天前开始使用血栓预防治疗的儿童无一例发生血栓形成。血栓预防治疗每延迟一天，发生血栓形成的可能性增加 30%（优势比 1.3；95%置信区间 1.1-1.6，P < 0.01）。服用阿司匹林的患儿与其他血栓预防治疗类型患儿发生血栓形成的几率无差异。在术后第 2 天以后开始使用血栓预防治疗的患者中，Fontan 术后早期 Fontan 环血栓形成的几率增加，而开始服用阿司匹林的患者与开始服用其他血栓预防治疗的患者发生血栓形成的几率无差异。建议术后早期开始使用阿司匹林以降低发病率。
