Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease.

Mongeon, François-Pierre; Macle, Laurent; Beauchesne, Luc M; Bouma, Berto J; Schwerzmann, Markus; Mulder, Barbara J M; Khairy, Paul (2019). Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease. Canadian journal of cardiology, 35(12), pp. 1686-1697. Elsevier 10.1016/j.cjca.2019.06.022

Preview	Text 1-s2.0-S0828282X1930443X-main.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Preview
	Text 1-s2.0-S0828282X1930443X-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (608kB)

Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have several advantages over VKAs that render them an attractive option for adults with congenital heart disease (CHD). Efficacy and safety data specific to the adult CHD population are emerging. Herein, we synthesize the growing literature regarding NOACs in adults with CHD and attempt to identify subgroups for which it appears reasonable to extrapolate data from populations without CHD. Small observational studies suggest that NOACs are safe and effective in selected adults with CHD. NOACs are contraindicated in patients with a mechanical valve, in those with mitral or tricuspid valve stenosis with enlarged and diseased atria, with or without a mitral or tricuspid bioprosthesis, and after recent cardiac surgery (< 3 months). There is currently insufficient evidence to recommend NOACs in patients with a Fontan circulation or cyanotic CHD. Growing literature supports the use of NOACs in patients without CHD who have various forms of valvular heart disease. Therefore, when an indication for oral anticoagulation is established, it appears reasonable to consider a NOAC instead of a VKA in adults with CHD lesions analogous to isolated mitral regurgitation, tricuspid regurgitation, or aortic regurgitation or stenosis. The NOAC agent selected and the prescribed dose should be tailored according to bleeding risk, body weight, renal function, and comedications, especially antiepileptic drugs. The decision to initiate a NOAC should be shared between the patient and care provider. Large-scale research studies are required to further assess safety and efficacy in selected patient subgroups.

Interest & Impact

Downloads

498 since deposited on 05 Dec 2019
77 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item