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

Détails

ID Serval
serval:BIB_1754CFCA6825
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Anticoagulation practices in adults with congenital heart disease and atrial arrhythmias in Switzerland.
Périodique
Congenital heart disease
Auteur(s)
Arslani K., Notz L., Zurek M., Greutmann M., Schwerzmann M., Bouchardy J., Engel R., Attenhofer Jost C., Tobler D.
Collaborateur(s)
SACHER investigators
ISSN
1747-0803 (Electronic)
ISSN-L
1747-079X
Statut éditorial
Publié
Date de publication
09/2018
Peer-reviewed
Oui
Volume
13
Numéro
5
Pages
678-684
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
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.
Mots-clé
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
Création de la notice
31/07/2018 11:13
Dernière modification de la notice
20/08/2019 13:47
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