Adkins Kira, Williams Ryan J, Esteso Paul, Kobayashi Ryan, Gauvreau Kimberlee, VanderPluym Christina, Hellinger Amy
Pharmacy Department, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Heart Center, Boston Children's Hospital, Boston, MA, USA.
Pediatr Cardiol. 2024 Sep 12. doi: 10.1007/s00246-024-03641-3.
Patients with Fontan physiology are at heightened risk of thrombosis related to passive venous return leading to increased stasis, as well as acquired thrombophilia from congestive hepatopathy. Variability exists for post-Fontan thromboprophylaxis, with no consensus on best practices. Direct oral anticoagulants offer advantages over conventional anticoagulants including fewer drug-drug interactions, no dietary restrictions, and less frequent monitoring. Herein, we report our single center experience utilizing apixaban thromboprophylaxis in children post-Fontan procedure. Single center, retrospective, cohort study evaluating apixaban thromboprophylaxis dosing strategies, efficacy, and safety in children admitted post-Fontan procedure at Boston Children's Hospital. Between September 2019 and December 2023, 62 children, median age 3.2 years (2.1-10.5 years), weight 13.9 kg (9.5-56.3 kg) received apixaban at a median of 93 days post-Fontan (7-1421 days). Over a total of 93 days of apixaban exposure, there was 1 treatment-related thrombosis event (0.07 per 1000 person-days on apixaban) and 3 combined treatment-related clinically relevant non-major (CRNM) and major bleeding events (0.22 per 1000 person-days on apixaban). Apixaban for post-Fontan thromboprophylaxis was feasible with low rates of bleeding and thrombosis.
接受Fontan手术的患者因被动静脉回流导致血流淤滞增加，以及因充血性肝病导致获得性血栓形成倾向，血栓形成风险升高。Fontan手术后的血栓预防措施存在差异，对于最佳实践尚无共识。直接口服抗凝剂相对于传统抗凝剂具有优势，包括更少的药物相互作用、无饮食限制以及监测频率更低。在此，我们报告我们在波士顿儿童医院对接受Fontan手术的儿童使用阿哌沙班进行血栓预防的单中心经验。这是一项单中心、回顾性队列研究，评估阿哌沙班在波士顿儿童医院接受Fontan手术后入院儿童中的预防给药策略、疗效和安全性。在2019年9月至2023年12月期间，62名儿童，中位年龄3.2岁（2.1 - 10.5岁），体重13.9千克（9.5 - 56.3千克）在Fontan手术后中位93天（7 - 1421天）接受了阿哌沙班治疗。在总共93天的阿哌沙班暴露期间，有1例与治疗相关的血栓形成事件（阿哌沙班治疗期间每1000人日0.07例）和3例与治疗相关的合并临床相关非大出血（CRNM）和大出血事件（阿哌沙班治疗期间每1000人日0.22例）。阿哌沙班用于Fontan手术后的血栓预防是可行的，出血和血栓形成发生率较低。
