Strategies for thromboprophylaxis in Fontan circulation: a network meta-analysis

Abstract Introduction The Fontan circulation is associated with an increased risk of thromboembolic events. However, the optimal strategy for thromboprophylaxis in this population remains unknown. Purpose aim study was to compare efficacy and safety aspirin, warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) a network meta-analysis using no as common comparator. Methods A comprehensive search performed Medline, Embase, Cochrane, Scopus identify relevant observational studies randomized controlled trials published by February 14th, 2022. primary outcome events at longest available follow-up, while major bleeding secondary outcome. Frequentist meta-analyses were conducted estimate incidence rate ratios (IRRs) corresponding 95% confidence intervals (CI) both outcomes. Finally, ranking treatments based on probability (P) score. Results total 25 included, encompassing 26,823 patient-years (aspirin: 11,948; warfarin: 11,354; NOAC: 346; thromboprophylaxis: 3,175). When compared thromboprophylaxis, NOACs (IRR 0.12, CI 0.03–0.41), warfarin 0.23, 0.14–0.36), aspirin 0.26, 0.16–0.40) all significantly lower rates revealed significant differences any strategies, although numerically higher (NOAC: IRR 1.45, 0.28–7.43; 1.38, 0.41–4.69; aspirin: 0.72, 0.20–2.58, Figure 1). Rankings, which simultaneously analyze competing interventions, suggested best prevent (P score 0.919), followed 0.615), 0.466), 0.001). Conclusions greatest reduction difference when aspirin. Funding Acknowledgement Type funding sources: None.