Thromboembolic and bleeding events in patients with Fontan circulation: A long-term follow-up study - 27/08/26
, Candice Oger 1, Pauline David 1, Caroline Ghanime 1, Alexis Barat 1, Antoine Legendre 1, Anne-Solene Chaussade 1, Pascal Lim 2, Laurence Iserin 3, Victor Waldmann 1Résumé |
Introduction |
Thrombosis and bleeding are specific risks in patients with a Fontan circulation, related to its unique physiology. The optimal thromboprophylaxis strategy in these patients remains debated throughout life. The aim of our study was to describe thromboembolic and major bleeding events and to identify risk factors and high-risk periods across the lifespan.
Methods |
We conducted a retrospective, observational, single-center study including the entire cohort of Fontan patients followed at a tertiary care center. All patients with a Fontan circulation under follow-up were included, and all relevant clinical events occurring throughout their lives were collected. The primary endpoint was a thromboembolic event. The secondary endpoint was a major bleeding event.
Results |
A total of 163 patients were included, with a median age of 33.47 years [28.01–41.66]; 96 (58.9%) were women. During follow-up, 24 thromboembolic events were recorded, including 12 thromboembolic events and 12 ischemic strokes, with a median age at event of 23.70 years [15.85–32.44]. No risk factors were identified other than the absence of thromboprophylactic treatment with vitamin K antagonists ( P < 0.001) or aspirin ( P < 0.001). Twenty-two major bleeding events occurred during follow-up, most commonly hemoptysis (8 events, 36.4%), with a median age at event of 27.40 years [24.11–33.40]. No significant increase in bleeding risk was observed with aspirin ( P = 0.55) or vitamin K antagonists ( P = 0.46) compared with no treatment ( Fig. 1 ).
Conclusion |
This is the first study with such long-term follow-up describing major ischemic and bleeding events throughout the lives of patients with a Fontan circulation. We identified the transition period as a critical stage for thromboembolic events, likely promoted by insufficient therapeutic education and loss to follow-up during this period. The absence of thromboprophylactic treatment and poor adherence appear to be the main determinants of thromboembolic events. Our findings support recent AHA guidelines while also highlighting specific high-risk periods for thromboembolic complications.
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Vol 119 - N° 8-9S
P. S242-S243 - août 2026 Retour au numéro
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