Peer-reviewed article
Evaluating the Impact of an Institutional Practice Change from Warfarin to Therapeutic Rivaroxaban Post-Fontan Operation.
Joel Livingston, Leanne Meakins, Jennifer Conway, Alanna Ash, Luke Eckersley et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study is not relevant to child well-being as defined by the African Institute for Children Studies. It focuses on a specific clinical intervention (anticoagulation strategy) for a rare congenital heart condition in children undergoing Fontan surgery, comparing warfarin to rivaroxaban. While it involves pediatric patients, it addresses acute medical management of a surgical complication rather than child well-being, development, protection, or participation outcomes that are the focus of the institute's work.
Key points
Limitations
Not applicable - document is outside scope of child well-being research.
Abstract
Thrombotic complications post-Fontan operation remain a significant clinical concern and preventing these events is critical to improve patient outcomes. While the optimal strategy for thromboprophylaxis post-Fontan is unclear, recent randomized studies have shown comparable outcomes in patients started on Direct Oral Anticoagulants (DOACs) as compared to either antiplatelet medications (e.g. aspirin) or anticoagulants (e.g. warfarin). Based on this increasing data, the Stollery Children's Hospital (primary pediatric cardiac surgical site for Western Canada) changed the standard thromboprophylaxis strategy in May 2024 from anticoagulation with warfarin (target international normalized ratio (INR) 2-3) to treatment dose rivaroxaban (adult equivalent dose 20 mg daily). The goal of this pilot study was to compare outcomes of the first 20 patients during the rivaroxaban period to the most recent 20 patients prior to the practice change. All patients who underwent Fontan procedure March/2023-April/2024 (warfarin cohort) and May/2024-September/2025 (rivaroxaban cohort) were identified and data on bleeding/thrombotic outcomes, length of hospital stay, and laboratory monitoring was collected through retrospective review of the electronic medical record including from surgical admission until 30 days post-discharge. All patients started on rivaroxaban had peak-rivaroxaban-calibrated-anti-Xa used to monitor dosing. During the study period, no significant bleeding or thrombotic events occurred post initiation of rivaroxaban, in the warfarin cohort there was one episode of clinically relevant non-major bleeding. Results suggest that thromboprophylaxis post-Fontan procedure with treatment dose rivaroxaban had similar early outcomes to warfarin. Future work is needed to validate these results in a larger cohort and include longer-term patient outcomes.