Pathophysiology of thrombosis and anticoagulation post Fontan surgery.

Abstract The Fontan procedure has transformed the lives of children born with single-ventricle physiology, previously deemed inoperable. Worldwide, there are an increasing number of children with Fontan circulation, with the potential for survival into adulthood. Due to the abnormal circulation, Fontan patients have an increased risk of thromboembolic (TE) events, with up to 25% of events leading to death. Despite the importance of preventing TE events in this patient population, there is currently no clinical consensus on the optimal monitoring, thromboprophylaxis therapies, and treatment of these events. This paper reviews the available literature regarding anticoagulation in the pediatric and adult Fontan population, including the mechanisms for thrombosis and current antithrombotic therapies. Highlights • The Fontan procedure is the definitive palliation for babies born with single ventricle physiology • Refinements in surgery and peri-operative care has meant there is a growing population of people living with a Fontan • Fontan patients are at an increased risk of develop thromboembolism due to a multitude of factors • Thromoboprophylaxis with aspirin or warfarin is usually recommended however evidence for efficacy is limited [ABSTRACT FROM AUTHOR]