Association between warfarin use and thromboembolic events in patients post-Fontan operation: propensity-score overlap weighting analyses.

IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS European Journal of Cardio-Thoracic Surgery Pub Date : 2024-11-28 DOI:10.1093/ejcts/ezae413
Wakana Maki, Shotaro Aso, Ryo Inuzuka, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
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Abstract

Objectives: The appropriate antithrombotic regimen after a Fontan operation is yet to be elucidated. Hence, this study aimed to compare the incidence of thromboembolic events in patients with and without receiving warfarin for thromboprophylaxis in a large post-Fontan population.

Methods: This retrospective cohort study used data from the Diagnosis Procedure Combination database in Japan between April 2011 and March 2022. We identified all patients who underwent a Fontan operation and excluded those who were born before 2010, died during the hospitalization or received mechanical heart replacement. Propensity score overlap weighting was performed between patients discharged with warfarin (with or without aspirin) and the control group (only aspirin or neither aspirin nor warfarin). Cox and Fine-Gray hazards models compared thromboembolic and bleeding events.

Results: We identified 2007 eligible patients, including 1670 warfarin users and 337 non-users. The mean follow-up duration was 2.1 years. The crude proportions of thromboembolic events were 3.0% and 3.0% and those of bleeding events were 0.4% and 0.3% in the warfarin and control groups, respectively. There was no significant difference in thromboembolic events between the groups (sub-distribution hazard ratio: 0.77; 95% confidence interval 0.39-1.51; P = 0.45) or bleeding events (sub-distribution hazard ratio: 0.78; 95% confidence interval 0.09-7.03; P = 0.83).

Conclusions: Warfarin use at discharge after a Fontan operation may not be necessary for thromboembolism prophylaxis in paediatric patients, based on large-scale real-world data, with a mean postoperative follow-up duration of 2.1 years. There is room for further studies to reconsider routine warfarin use in patients post-Fontan operation.

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芳坦手术后患者使用华法林与血栓栓塞事件之间的关系:倾向分数重叠加权分析。
目的:方坦手术后的适当抗血栓治疗方案尚未明确。因此,本研究旨在对大量接受和未接受华法林血栓预防治疗的丰坦术后患者的血栓栓塞事件发生率进行比较:这项回顾性队列研究使用了 2011 年 4 月至 2022 年 3 月期间日本诊断程序组合数据库中的数据。我们确定了所有接受丰坦手术的患者,并排除了2010年之前出生、住院期间死亡或接受机械心脏置换的患者。在使用华法林(含或不含阿司匹林)出院的患者与对照组(仅使用阿司匹林或既不使用阿司匹林也不使用华法林)之间进行倾向得分重叠加权。Cox和Fine-Gray危险度模型比较了血栓栓塞和出血事件:我们确定了 2,007 名符合条件的患者,包括 1,670 名使用华法林的患者和 337 名未使用华法林的患者。平均随访时间为 2.1 年。在华法林组和对照组中,血栓栓塞事件的粗略比例分别为 3.0% 和 3.0%,出血事件的粗略比例分别为 0.4% 和 0.3%。组间血栓栓塞事件(次分布危险比:0.77;95% 置信区间:0.39-1.51;P = 0.45)或出血事件(次分布危险比:0.78;95% 置信区间:0.09-7.03;P = 0.83)无明显差异:结论:根据术后平均随访时间为 2.1 年的大规模真实世界数据,儿科患者在丰坦手术后出院时使用华法林预防血栓栓塞可能并无必要。仍有进一步研究的余地,以重新考虑在方坦手术后患者中常规使用华法林。
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来源期刊
CiteScore
5.60
自引率
11.80%
发文量
564
审稿时长
2 months
期刊介绍: The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. The European Journal of Cardio-Thoracic Surgery is an international journal and accepts submissions from all regions. The journal is supported by a number of leading European societies.
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