Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease

Publication date: December 2019Source: Canadian Journal of Cardiology, Volume 35, Issue 12Author(s): François-Pierre Mongeon, Laurent Macle, Luc M. Beauchesne, Berto J. Bouma, Markus Schwerzmann, Barbara J.M. Mulder, Paul KhairyAbstractNon-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have several advantages over VKAs that render them an attractive option for adults with congenital heart disease (CHD). Efficacy and safety data specific to the adult CHD population are emerging. Herein, we synthesize the growing literature regarding NOACs in adults with CHD and attempt to identify subgroups for which it appears reasonable to extrapolate data from populations without CHD. Small observational studies suggest that NOACs are safe and effective in selected adults with CHD. NOACs are contraindicated in patients with a mechanical valve, in those with mitral or tricuspid valve stenosis with enlarged and diseased atria, with or without a mitral or tricuspid bioprosthesis, and after recent cardiac surgery (< 3 months). There is currently insufficient evidence to recommend NOACs in patients with a Fontan circulation or cyanotic CHD. Growing literature supports the use of NOACs in patients without CHD who have various forms of valvular heart disease. Therefore, when an indication for oral anticoagulation is established, it appears reasonable to consider a NOAC instead of a VKA in adults with CHD lesions analogous to isolated mitral regurgitation, tricuspid regurgitation, or a...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research