{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:49:59Z","timestamp":1753886999953,"version":"3.41.2"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Available outcomes data for anticoagulation therapy in adults with congenital heart disease (\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              ) provide assessment of global risk of this therapy for\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              patients (a heterogeneous population), but the risk of complications for the different\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              diagnoses is unknown. The purpose of the study was to describe the indications for anticoagulation, and the incidence and risk factors for major bleeding complication in adults with tetralogy of Fallot.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We queried Mayo Adult Congenital Heart Disease (MACHD) database for tetralogy of Fallot patients (aged \u226518\u00a0years) that received anticoagulation, 1990\u20132017. Of 130 patients (42\u00b114\u00a0years, 75 men [58%]), warfarin and direct oral anticoagulants were used in 125 (96%) and 5 (4%), respectively because atrial arrhythmias (n=109), mechanical prosthetic valve (n=29), intracardiac thrombus (n=4), pulmonary embolism (n=6), stroke (n=3), and perioperative anticoagulation (n=44). The median hypertension, abnormal renal or liver function; stroke; bleeding history or predisposition; labile international normalized ratio; elderly (&gt;65\u00a0years); drug or alcohol use score for the entire cohort was 1 (0\u20132) and 27 (21%) had hypertension, abnormal renal or liver function; stroke; bleeding history or predisposition; labile international normalized ratio; elderly (&gt;65\u00a0years); drug or alcohol use score \u22652. There were 14 minor bleeding events (1.6% per year) and 11 major bleeding events (1.3% per year) in 8 patients during median follow\u2010up of 74\u00a0months (856\u00a0patient\u2010years). Mechanical prosthesis (hazard ratio 1.78,\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.29\u20133.77,\n              <jats:italic>P<\/jats:italic>\n              =0.021) and hypertension, abnormal renal or liver function; stroke; bleeding history or predisposition; labile international normalized ratio; elderly (&gt;65\u00a0years); drug or alcohol use score \u22652 (hazard ratio 1.41,\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.03\u20133.88,\n              <jats:italic>P<\/jats:italic>\n              =0.046) were risk factors for major bleeding events. All\u2010cause mortality was higher in patients with major bleeding events (n=6, 75%) compared with patients without major bleeding events (n=25, 21%),\n              <jats:italic>P<\/jats:italic>\n              =0.001.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Considering the heterogeneity of the\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              population, data from the current study may be better suited for clinical decision\u2010making in tetralogy of Fallot patients.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.011474","type":"journal-article","created":{"date-parts":[[2019,2,26]],"date-time":"2019-02-26T10:00:40Z","timestamp":1551175240000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of Anticoagulation Therapy in Adults With Tetralogy of Fallot"],"prefix":"10.1161","volume":"8","author":[{"given":"Alexander C.","family":"Egbe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William R.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naser M.","family":"Ammash","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkata R.","family":"Missula","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raja","family":"Jadav","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Najam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srikanth","family":"Kothapalli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi M.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","article-title":"2018 AHA\/ACC guideline for the management of adults\u00a0with congenital heart disease","author":"Stout KK","year":"2018","unstructured":"Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA\/ACC guideline for the management of adults\u00a0with congenital heart disease. 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