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Is non-vitamin K oral anticoagulants safe in Adult Congenital Heart Disease
Session:
Sessão Especial – Prémio Melhor Poster Electrónico
Speaker:
Miguel Martins de Carvalho
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Miguel Martins de Carvalho; Tânia Proença; Ricardo Alves Pinto; Catarina Costa; Filipa Amador; João Calvão; Catarina Marques; André Cabrita; Cristina Cruz; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#222222"><span style="background-color:#ffffff"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Adult with Congenital Heart Disease (CHD) are an increasing population with known high risk for thromboembolic events. Validation scores as CHA2DS2-VASC and HAS-BLED are uncertainty and, differently from patients with acquired heart disease, data is scarce about the use of non-vitamin K oral anticoagulants (NOAC) in this population. Although apparently safe its use remain off-label and more studies are warranted.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="color:#222222"><span style="background-color:#ffffff"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To evaluate all patients requiring anticoagulation on-NOAC followed in an Adult CHD <span style="color:red">(ACHD)</span> outpatients clinic and observe its safety and efficacy in thromboembolic prevention during a median follow-up of 60 months. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="color:#222222"><span style="background-color:#ffffff"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: In our population of 65 patients on NOAC with a mean age of 52 year-old, 66% were female. Most frequent CHD were atrial septal defect (22%) and Tetralogy of Fallot (TOF, 22%), followed by atrioventricular septal defect (16%). Regarding cardiovascular risk factors, 37% had hypertension, 23% had dyslipidemia, 9% had diabetes, 8% were smokers or previous smokers and 23% had obesity. Most patients had normal systolic function; 20% and 12% had respectively systemic and subpulmonic systolic dysfunction. About 63% of patients were in sinus rhythm, 35% in atrial fibrillation or flutter (AF/AFL) and 2% had pace rhythm. About 40% of patients had a CHA2DS2-VASC score ≥ <span style="color:red">2</span> and a median HAS-BLED of <span style="color:red">0</span>. The main reason for anticoagulation was AF/AFL in 94% of patients; the remaining had an ischemic stroke (3%), intra-cardiac thrombus (2%) or a deep venous thrombosis (2%). About 69% of patients were medicated with beta blocker, 6% with amiodarone and 5% with another anti-arrhythmic drug. Concerning to NOACs 43% were medicated with apixaban, 29% with rivaroxaban, 22% with edoxaban and 6% with dabigatran. During the median follow-up of 60 months, only 5% had ischaemic complications; 2 patients had an ischemic stroke and 1 an acute myocardial infarct while on rivaroxaban-therapy. No statistically difference was found among the different NOACs (p=0.55). There were no haemorrhagic complications and one patient died during the follow-up.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="color:#222222"><span style="background-color:#ffffff"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Of our population on-NOAC, most had ASD and TOF, and the main reason for anticoagulation was AF/AFL. Most patients were on apixaban. Only 5% of patients developed complications, with no statistically difference between drugs. NOACs seems safe and effective in adult with CHD.</span></span></span></span></p>
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