Introduction Novel oral anticoagulants (NOACs) are increasingly used in patients with arrhythmias to prevent embolic events. Simplicity of use, with no requirement for INR monitoring and dose alteration, has driven the rise in NOAC prescription for patients with adult congenital heart disease (ACHD). We provide a summary of one centre’s experience of the use of NOACs in ACHD.
Methods All patients with ACHD treated with NOACs in our heart centre were retrospectively enrolled and data was collected from clinic letters.
Results Between November 2012 and February 2015, 13 patients with ACHD in the Oxford Heart Centre were prescribed NOACs (dabigatran: n = 7; rivaroxaban: n = 5; apixaban: n = 1) for atrial flutter (n = 5), atrial fibrillation (n = 3), supraventricular tachycardia, Fontan circulation, previous pulmonary emboli and a blind ending pulmonary artery. The use of NOACs was acceptable in ACHD patients with learning difficulties, poor venous access, and for whom travel to hospital is difficult.
Overall four patients reported side-effects after starting NOACs. Two of those on dabigatran experienced gastrointestinal symptoms. One patient on rivaroxaban reported bleeding from a Hickman line and menorrhagia that was improved by the progestogen-only pill. Another patient on rivaroxaban reported migraines.
Conclusions Warfarin remains first line for arrhythmias in ACHD, however, the use of NOACs in such patients is increasing. The lack of regular INR measurements and dose alterations is particularly convenient in this population, who have undergone multiple medical interventions in their lifetime, and side effects are infrequent.
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