Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland.

Arslani, Ketina; Notz, Lukas; Zurek, Marzena; Greutmann, Matthias; Schwerzmann, Markus; Bouchardy, Judith; Engel, Reto; Attenhofer Jost, Christine; Tobler, Daniel (2018). Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland. Congenital heart disease, 13(5), pp. 678-684. Wiley 10.1111/chd.12627

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BACKGROUND In adults with congenital heart disease (CHD) and atrial arrhythmias, recommendations for thromboprophylaxis are vague and evidence is lacking. We aimed to identify factors that influence decision-making in daily practice. METHODS From the Swiss Adult Congenital HEart disease Registry (SACHER) we identified 241 patients with either atrial fibrillation (Afib) or atrial flutter/intraatrial reentrant tachycardia (Aflut/IART). The mode of anticoagulation was reviewed. Logistic regression models were used to assess factors that were associated with oral anticoagulation therapy. RESULTS Compared with patients with Aflut/IART, patients with Afib were older (51 ± 16.1 vs 37 ± 16 years, P < .001) and had a higher CHA DS -VASc (P < .001) and HAS-BLED scores (P = .005). Patients with Afib were more likely on oral anticoagulation than patients with Aflut/IART (67% vs 43%, P < .001). In a multivariate logistic regression model, age [odds ratio (OR) 1.03 per year, 95%CI (1.01-1.05), P = .019], atrial fibrillation [OR 2.75, 95%CI (1.30-5.08), P = .007], non-paroxysmal atrial arrhythmias [OR 5.33, 95%CI (2.21-12.85)], CHA DS -VASc-Score >1 [OR 2.93, 95%CI (1.87-4.61), P < .001], and Fontan palliation [OR 17.5, 95%CI (5.57-54.97), P < .001] were independently associated with oral anticoagulation treatment, whereas a HAS-BLED score >1 was associated with absence of thromboprophylaxis [OR 0.32, 95%CI (0.17-0.60), P < .001]. CONCLUSIONS In this multicenter study, age, type, and duration of atrial arrhythmias, CHA DS -VASc and HAS-BLED scores as well as a Fontan palliation had an impact on the use of thromboprophylaxis in adult CHD patients with atrial arrhythmias. In daily practice, anticoagulation strategies differ between patients with Afib and those with Aflut/IART. Prospective observational studies are necessary to clarify whether this attitude is justified.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Schwerzmann, Markus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1747-0803

Publisher:

Wiley

Language:

English

Submitter:

Markus Schwerzmann

Date Deposited:

24 Jan 2019 16:22

Last Modified:

05 Dec 2019 08:52

Publisher DOI:

10.1111/chd.12627

PubMed ID:

30033686

Uncontrolled Keywords:

anticoagulation atrial arrhythmia congenital heart disease thromboprophylaxis

BORIS DOI:

10.7892/boris.122678

URI:

https://boris.unibe.ch/id/eprint/122678

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