UPMC Children’s Heart Institute Team Publishes Exciting New Research on Thromboprophylaxis in Fontan Circulation

February 6, 2023

Researchers from the Heart Institute at UPMC Children’s Hospital of Pittsburgh and the Department of Pediatrics at the University of Pittsburgh School of Medicine published new findings in the Journal of the American College of Cardiology on methods of thromboprophylaxis and their efficacy in patients with Fontan circulation.

Tarek Alsaied, MD,MSc, was the study’s senior author. Also contributing to the investigation from UPMC Children’s were Bryan Goldstein, MD, FACC, FASCI, director of the Cardiac Catheterization Laboratory, Arvind Hoskoppal, MD, MHS, director of the Adult Congenital Heart Disease (ACHD) Program at UPMC Children’s, Anita Saraf MD, PhD, also from the ACHD Program, and Brian Feingold, MD, MS, FAHA, medical director of the Heart Failure and Transplantation Programs at UPMC Children’s.

About 1 in 10,000 children are born with a specific kind of heart defect (single ventricle) that requires a surgical treatment called a Fontan palliation, wherein the typical blood flow in the heart is to bypass the hypoplastic ventricle. Long-term antithrombotic prophylaxis is then typically prescribed to manage the potential for catastrophic clotting cardiac events. However, it is estimated that approximately 50% of all people in the United States living with Fontan palliation are under the age of 18 and have a more difficult time with related side effects of current anticoagulation treatments, including compliance and improper dosing levels. 

The meta-analysis performed by Dr. Alsaied and colleagues demonstrates that the most effective treatment to reduce the potential for catastrophic cardiac events is a regular dose of aspirin in these pediatric populations and that in high-risk patients a non-vitamin K anticoagulant can be safely and effectively used. This conclusion is a highly significant finding in the field of cardiology, as questions of appropriate long-term care of Fontan palliation have lingered among pediatric cardiologists for decades. 

The Journal of the American College of Cardiology is recognized as one of the top cardiology journals in the world, signifying the incredible step-forward this new research represents for pediatric cardiac patients.


van den Eynde J, Possner M, Alahdab F, Veldtman G, Goldstein BH, Rathod RH, Hoskoppal AK, Saraf A, Feingold B, Alsaied T. Thromboprophylaxis in Patients With Fontan Circulation. J Am Coll Cardiol. 2023; 81(4): 374-389.