ArticleJournal of thrombosis and thrombolysis2026
Low-grade endotoxemia as an additional prothrombotic mechanism in adults with Fontan circulation.
Article in Journal of thrombosis and thrombolysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The Fontan procedure, the standard palliation for single-ventricle congenital heart disease, is associated with a high burden of thromboembolic complications of unclear etiology. We investigated whether increased circulating lipopolysaccharide (LPS) related to a compromised intestinal barrier is involved in thromboembolic manifestations and markers in the Fontan population. We examined 48 stable adults with Fontan circulation (median age 23 years; range 18-40) and 31 age-matched controls. We assessed serum LPS, and zonulin (marker of increased gut permeability), along with coagulation factors (F; prothrombin, FV, FVII-FX), thrombin generation (prothrombin fragment 1 + 2, thrombin-antithrombin complexes), endogenous anticoagulants (antithrombin, free protein S, tissue factor pathway inhibitor), markers of fibrinolysis (α2-antiplasmin, clot lysis time, plasminogen activator inhibitor-1, thrombin-activatable fibrinolysis inhibitor), platelet activation (P-selectin, sCD40L), and endothelial injury (von Willebrand factor (vWF), thrombomodulin). Compared with controls, patients with Fontan circulation exhibited higher LPS (+ 207%) and zonulin (+ 125%), which were strongly correlated (r = 0.63; P < 0.001). In the Fontan group, LPS was positively associated with vWF (r = 0.76; P < 0.001), and inversely with free protein S (r = - 0.30; P = 0.04), but not with any other markers. Ten patients (21%) with prior thromboembolic events had higher adjusted (age, sex, BMI) LPS (+ 198%; P < 0.001) and zonulin (+ 147%; P < 0.001) compared with remainder, accompanied by higher vWF (+ 119%), P-selectin (+ 137%), sCD40L (+ 139%), as well as lower FVIII (- 20%) and protein S (- 22%). We are the first to report that patients with Fontan circulation exhibit higher LPS levels related to increased intestinal permeability, which may predispose to thromboembolism and have practical implications.
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