Thromboprophylaxis for atrial arrhythmias in congenital heart disease: A multicenter study. (15th November 2016)

• Record Type: Journal Article
• Authors: Khairy, Paul; Aboulhosn, Jamil; Broberg, Craig S.; Cohen, Scott; Cook, Stephen; Dore, Annie; Fernandes, Susan M.; Fournier, Anne; Kay, Joseph; Levesque, Sylvie; Macle, Laurent; Marcotte, François; Mondésert, Blandine; Mongeon, François-Pierre; Opotowsky, Alexander R.; Proietti, Anna; Rivard, Lena; Ting, Jennifer; Thibault, Bernard; Zaidi, Ali; Hamilton, Robert
• Is Part Of: International journal of cardiology. Volume 223(2016)
• Page Start: 729
• Page End: 735
• Publication Date: 2016-11-15
• Subjects: AARCC Alliance for Adult Research in Congenital Cardiology -- ANOVA Analysis of variance -- CHADS2 A risk score that assigns one point each to history of congestive heart failure, hypertension, and diabetes mellitus, one point for age > 75 years, and two points for prior stroke, transient ischemic attack (TIA), or systemic emboli -- CHA2DS2-VASc A risk score that assigns one point each to history of congestive heart failure, hypertension, diabetes mellitus, vascular disease, and female sex, one point for age 65 to 74 years, two points for age ≥ 75 years, and two points for prior stroke, TIA, or systemic emboli -- CI Confidence interval -- CRF Case-report form -- HAS-BLED A risk score that assigns one point each for history of hypertension, renal disease, liver disease, history of stroke, prior major bleeding or predisposition to bleeding, labile international normalized ratio, age > 65 years, antiplatelet or non-steroidal anti-inflammatory drug, and alcohol consumption (> 8 drinks/week) or illicit drug use -- HR Hazard ratio -- IART Intra-atrial reentrant tachycardia -- IQR Inter-quartile range -- MHICC Montreal Health Innovations Coordinating Center -- NAFAT Non-automatic focal atrial tachycardia -- NOAC Newer oral anticoagulant -- NYHA New York Heart Association -- TACTIC The Anticoagulation Therapy in Congenital Heart Disease study -- TIA Transient ischemic attack; Congenital heart disease -- Atrial tachycardia -- Thromboembolic event -- Bleeding -- Antiplatelet therapy -- Anticoagulation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.08.223
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease. Methods: A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. Results: A total of 482 patients, 45.2% female, age 32.0 ± 18.0 years, were followed for 11.3 ± 9.4 years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital heart disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7 ± 2.7% at 15 years, with no difference between anticoagulation versus antiplatelet therapy (P = 0.97). Congenital heart disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P < 0.001). CHADS2 and CHA2 DS2 -VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P = 0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05–21.58), P = 0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P = 0.047] were independently associated with major bleeds. Conclusion: Current management of atrial arrhythmias in congenital heart disease is associated with a modest rate of thromboembolic events, which is predicted by disease complexity but not CHADS2 /CHA2 DS2 -VASc scores. HAS-BLED score is applicable to the congenital population in predicting major bleeds.