ArticleOpen heart
Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe.
Article in Open heart. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Optimal Strategy for Thromboprophylaxis in Fontan Circulation: A Systematic Review and Meta-analysis with a Focus on Ethnic Differences.Pediatric cardiology · 2026Pooled it
- Safety and Efficacy of DOAC Versus VKA in Adult Congenital Heart Disease: A Systematic Review and Meta-Analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025Pooled it
- Systematic Review of Randomized Clinical Trials on Direct Oral Anticoagulants in Pediatric Heart Diseases.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Single Ventricle Fontan: The Basics for General Cardiologists.Methodist DeBakey cardiovascular journal · 2026Review
- Hypoplastic Left Heart Syndrome Practice Variation Across 31 Centres From 20 European Countries. An AEPC Imaging Working Group Study.European journal of pediatrics · 2025Article
- A new strategy for monitoring of direct oral anticoagulants in patients with cyanotic and complex congenital heart disease.International journal of cardiology. Congenital heart disease · 2024Article
- A Multisite Retrospective Review of Direct Oral Anticoagulants Compared to Warfarin in Adult Fontan Patients.Cardiovascular drugs and therapy · 2023Review
- Thromboembolic Complications in Adult Patients Following Fontan Procedure-A Multicenter Study.Journal of clinical medicine · 2023Article
- Thromboprophylaxis in Patients With Fontan Circulation.Journal of the American College of Cardiology · 2023Article
- Increased Risk for Thromboembolism After Fontan Surgery: Considerations for Thromboprophylaxis.Frontiers in pediatrics · 2022Article
- Thromboembolic complications in adult congenital heart disease: the knowns and the unknowns.Clinical research in cardiology : official journal of the German Cardiac Society · 2021Review
- Diagnosis and management of the adult patient with a failing Fontan circulation.Heart failure reviews · 2020Review
- Leaf: an open-source, model-agnostic, data-driven web application for cohort discovery and translational biomedical research.Journal of the American Medical Informatics Association : JAMIA · 2020Article
Corrections and comments
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Authors and funding
19 authors at 17 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: In Fontan patients with atrial arrhythmias (AA), non-vitamin K antagonist oral anticoagulants(NOACs) have a class III recommendation according to the Pediatric & Congenital Electrophysiology Society (PACES)/Heart Rhythm Society (HRS) guideline in 2014, due to lack of data on outcomes as opposed to evidence of harm. To address this gap in data, we investigated the safety and efficacy of NOACs in adults with a Fontan circulation in a worldwide study. Methods: This is an international multicentre prospective cohort study, using data from the NOTE ( Results: From April 2014 onward, 74 patients (mean age 32±10 years (range 18-68), 54% male) with a Fontan circulation using NOACs were included. During a median follow-up of 1.2 (IQR 0.8-2.0) years, three thromboembolic events (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) and three major bleedings (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) occurred in five atriopulmonary Fontan and one total cavopulmonary connection Fontan patients with AA. Fifteen patients experienced minor bleeding episodes (15.8 per 100 patient-years (95% CI 9.1 to 25.2)). In patients (n=37) using vitamin K antagonists (VKAs) prior to the initiation of NOAC, annual incidence of historical thromboembolic events and major bleeding were 2.4% (95% CI 0.4% to 7.4%) (n = 2) and 1.2% (95% CI 0.7% to 5.1%) (n = 1), respectively. Conclusions: In this review of the largest Fontan cohort using NOACs with prospective follow-up, NOACs appear to be well tolerated and their efficacy and safety during short-term follow-up seem comparable to VKAs. Longer term data are required to confirm these promising short-term results.
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