Details

Autor(en) / Beteiligte

• Arslani, Ketina
• Notz, Lukas
• Zurek, Marzena
• Greutmann, Matthias
• Schwerzmann, Markus
• Bouchardy, Judith
• Engel, Reto
• Attenhofer Jost, Christine
• Tobler, Daniel

Titel

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

Ist Teil von

• Congenital heart disease, 2018-09, Vol.13 (5), p.678-684

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2018

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Background 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. Methods 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. Results Compared with patients with Aflut/IART, patients with Afib were older (51 ± 16.1 vs 37 ± 16 years, P < .001) and had a higher CHA2DS2‐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)], CHA2DS2‐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]. Conclusions In this multicenter study, age, type, and duration of atrial arrhythmias, CHA2DS2‐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.