Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland.

Details

Serval ID
serval:BIB_1754CFCA6825
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland.
Journal
Congenital heart disease
Author(s)
Arslani K., Notz L., Zurek M., Greutmann M., Schwerzmann M., Bouchardy J., Engel R., Attenhofer Jost C., Tobler D.
Working group(s)
SACHER investigators
ISSN
1747-0803 (Electronic)
ISSN-L
1747-079X
Publication state
Published
Issued date
09/2018
Peer-reviewed
Oui
Volume
13
Number
5
Pages
678-684
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
In adults with congenital heart disease (CHD) and atrial arrhythmias, recommendations for thromboprophylaxis are vague and evidence is lacking. We aimed to identify factors that influence decision-making in daily practice.
From the Swiss Adult Congenital HEart disease Registry (SACHER) we identified 241 patients with either atrial fibrillation (Afib) or atrial flutter/intraatrial reentrant tachycardia (Aflut/IART). The mode of anticoagulation was reviewed. Logistic regression models were used to assess factors that were associated with oral anticoagulation therapy.
Compared with patients with Aflut/IART, patients with Afib were older (51 ± 16.1 vs 37 ± 16 years, P < .001) and had a higher CHA <sub>2</sub> DS <sub>2</sub> -VASc (P < .001) and HAS-BLED scores (P = .005). Patients with Afib were more likely on oral anticoagulation than patients with Aflut/IART (67% vs 43%, P < .001). In a multivariate logistic regression model, age [odds ratio (OR) 1.03 per year, 95%CI (1.01-1.05), P = .019], atrial fibrillation [OR 2.75, 95%CI (1.30-5.08), P = .007], non-paroxysmal atrial arrhythmias [OR 5.33, 95%CI (2.21-12.85)], CHA <sub>2</sub> DS <sub>2</sub> -VASc-Score >1 [OR 2.93, 95%CI (1.87-4.61), P < .001], and Fontan palliation [OR 17.5, 95%CI (5.57-54.97), P < .001] were independently associated with oral anticoagulation treatment, whereas a HAS-BLED score >1 was associated with absence of thromboprophylaxis [OR 0.32, 95%CI (0.17-0.60), P < .001].
In this multicenter study, age, type, and duration of atrial arrhythmias, CHA <sub>2</sub> DS <sub>2</sub> -VASc and HAS-BLED scores as well as a Fontan palliation had an impact on the use of thromboprophylaxis in adult CHD patients with atrial arrhythmias. In daily practice, anticoagulation strategies differ between patients with Afib and those with Aflut/IART. Prospective observational studies are necessary to clarify whether this attitude is justified.
Keywords
Adult, Anticoagulants/administration & dosage, Atrial Fibrillation/complications, Atrial Fibrillation/drug therapy, Atrial Fibrillation/physiopathology, Female, Heart Defects, Congenital/complications, Heart Defects, Congenital/drug therapy, Humans, Incidence, Male, Middle Aged, Odds Ratio, Prospective Studies, Registries, Risk Assessment, Risk Factors, Switzerland/epidemiology, Thromboembolism/epidemiology, Thromboembolism/etiology, Thromboembolism/prevention & control, Thrombolytic Therapy/methods, Treatment Outcome, anticoagulation, atrial arrhythmia, congenital heart disease, thromboprophylaxis
Pubmed
Web of science
Create date
31/07/2018 10:13
Last modification date
20/08/2019 12:47
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