NOAC in adult congenital heart disease patients: a single-center experience

Abstract

Abstract Background Adult Congenital Heart Disease (ACHD) patients at increased risk for thromboembolic events are often treated with oral anticoagulation. While vitamin-K antagonists have been the agent of choice for decades, the use of non-vitamin K oral anticoagulants (NOAC) is increasing. We aimed to assess the safety and effectiveness of NOAC in ACHD patients at our centre. Methods This is a single-centre study enrolling all patients with ACHD treated with a NOAC from inception to November 2021. Data was collected using a standardized questionnaire applied to all patients by means of a telephone visit, in parallel with a detailed retrospective chart review. The endpoints of interest included thromboembolic and haemorrhagic events, defined as per the standardized International Society on Thrombosis and Haemostasis (ISTH) scale. Results Overall, 36 ACHD patients were enrolled [mean age 53±15 years; female sex – 66.7%; previous stroke – 33.3%; median HAS-BLED and CHA2DS2-VASc score – 1 (1–2) and 3 (2–5), respectively], predominantly with moderate or complex congenital defects (52.7%), of whom 14, 8, 8 and 4 were treated with rivaroxaban, apixaban, edoxaban and dabigatran, respectively. Two-thirds had their first NOAC prescription in the latest 3 years (Figure 1). The most common indication for anticoagulation was atrial fibrillation or flutter (77.8%). Over a median time of 36 (18–63) months on NOAC treatment, there were no patients with thromboembolic events, whilst 13 (36.1%) had a haemorrhagic event – annualized event rate of 12.0 (6.9–24.1%). All bleeding events were minor, most often self-limited gingival haemorrhage or epistaxis (n=7) or menorrhagia (n=3). Nasal cautery was needed to treat recurrent epistaxis in 3 patients, whilst 3 other required oral iron supplementation. The strongest predictor of any haemorrhage was a prior cardiovascular hospitalization (HR 3.88; p=0.027). Conclusions The use of NOAC in ACHD patients has been increasing in our centre, with encouraging results. The present findings suggest that NOAC are safe and may be effective for thromboembolic event prevention in heterogeneous forms of ACHD. Funding Acknowledgement Type of funding sources: None.