Anticoagulation therapy and thromboembolic complications in pediatric patients undergoing the Fontan procedure

Abstract

Objectives: We assessed the children with complex heart anomalies who undergone operative intervention of any form of Fontan intervention and analyzed them for thromboembolic complications after Fontan procedure performed at the Pediatric Clinic of Pristina.Background: Thromboembolic complications are a major cause of early and late mortality in children with single-ventricle congenital heart defects who have undergone a Fontan procedure.Thrombosis is an important and unpredictable complication, not only after Fontan operation but also associated with each stage of single-ventricle palliation. It is an important cause of morbidity, particularly when it leads to pulmonary embolism or stroke, and contributes to mortality.Methodology: The research was conducted at the Pediatric Clinic in the Cardiology and Intensive Care Service, during 2018-2021. The study includes patients who have undergone tertiary level intervention - one of the forms of the Fontan procedure, the research included 40 patients aged 0 -19 years. The children were divided into two groups: the group 29 patients using Aspirin therapy and the group of 11 patients without Aspirin therapy. In children after admission, laboratory tests were performed: hemogram, bleeding time, coagulation time, INR, PTT, and PT.Results: The mean age of children with antithrombotic therapy was 6.03 years (DS ± 5.84 years), those without therapy 3.27 years (DS ± 5.44 years). Aspirin as antithrombotic therapy was applied to 29 patients at a dose of 15 to 115 mg / 24 hours. In 6 patients the dose was less than 3-5 mg / kg body weight.Thepatients with congenital heart malformations after Fontan procedure receiving antithrombotic therapy are 1.4 times more likely to have reduced prothrombin time.Conclusions: Fontan procedure in children has been gratifying, with most survivors now leading lives of good quality into adulthood.