ArticleJournal of the American College of Cardiology2023
Thromboprophylaxis in Patients With Fontan Circulation.
Article in Journal of the American College of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 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
- Pharmacokinetics in the Fontan circulation: a multi-organ puzzle.European heart journal. Cardiovascular pharmacotherapy · 2026Review
- Contemporary Management and Future Directions of Adults Living With a Fontan Circulation.JACC. Advances · 2026Review
- Successful medical management of recurrent atrial arrhythmia in a non-eligible Fontan patient to ablation: case report and literature review.Annals of medicine and surgery (2012) · 2026Article
- Long-Term Outcomes of Antithrombotic Treatment in a Cohort of 864 Patients With Fontan Circulation.Journal of the American Heart Association · 2026Article
- Outcomes of a Physiology-driven Extracardiac Fontan Strategy Incorporating Computational Fluid Dynamics: A Multicentre Study.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Arrhythmia Management in Complex Congenital Heart Disease.JACC. Case reports · 2026Article
- The use of direct oral anticoagulants in children with congenital and acquired heart disease.Frontiers in cardiovascular medicine · 2026Review
- Evaluating the Impact of an Institutional Practice Change from Warfarin to Therapeutic Rivaroxaban Post-Fontan Operation.Pediatric cardiology · 2025Article
- Critical Care of the Adult With Congenital Heart Disease.JACC. Advances · 2025Review
- In vitro evaluation of global coagulation potential of emicizumab and warfarin using rotational thromboelastometry.International journal of hematology · 2025Article
- Managing High Risk Pregnancy in Single Ventricle Physiology with Acquired von Willebrand Disease: A Case Report.Reports (MDPI) · 2025Article
- European thromboprophylaxis practice amongst paediatric cardiology units.European journal of pediatrics · 2025Article
- Case report: a thrombus to remember: a case of warfarin non-compliance in a total cavopulmonary circulation patient.European heart journal. Case reports · 2025Article
- Impact of smoking on cardiovascular health: Mechanisms, epidemiology and specific concerns regarding congenital heart disease.International journal of cardiology. Congenital heart disease · 2025Review
- Systemic Changes in Adults With a Fontan Circulation: Insights From the Plasma Proteome.Journal of the American Heart Association · 2025Article
- Extracardiac Conduit Subocclusion in an Adult Patient With a Fontan Circulation.JACC. Case reports · 2025Article
- Thromboprophylaxis strategies for patients with a Fontan palliation: practice in the NHS.The British journal of cardiology · 2025Article
Corrections and comments
- Commented on by
Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundThe optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown.
objectivesThe aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis.
methodsRelevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score.
resultsA total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile.
conclusionsAspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.