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. 2025 Dec;46(8):2283-2290.
doi: 10.1007/s00246-024-03641-3. Epub 2024 Sep 12.

Real-World Use and Outcomes of Apixaban for Early Post-Surgical Fontan Thromboprophylaxis

Kira Adkins  1 , Ryan J Williams  2 , Paul Esteso  2 , Ryan Kobayashi  2 , Kimberlee Gauvreau  2 , Christina VanderPluym  2 , Amy Hellinger  2
Affiliations

Real-World Use and Outcomes of Apixaban for Early Post-Surgical Fontan Thromboprophylaxis

Kira Adkins et al. Pediatr Cardiol. 2025 Dec.

Abstract

Patients with Fontan physiology are at heightened risk of thrombosis related to passive venous return leading to increased stasis, as well as acquired thrombophilia from congestive hepatopathy. Variability exists for post-Fontan thromboprophylaxis, with no consensus on best practices. Direct oral anticoagulants offer advantages over conventional anticoagulants including fewer drug-drug interactions, no dietary restrictions, and less frequent monitoring. Herein, we report our single center experience utilizing apixaban thromboprophylaxis in children post-Fontan procedure. Single center, retrospective, cohort study evaluating apixaban thromboprophylaxis dosing strategies, efficacy, and safety in children admitted post-Fontan procedure at Boston Children's Hospital. Between September 2019 and December 2023, 62 children, median age 3.2 years (2.1-10.5 years), weight 13.9 kg (9.5-56.3 kg) received apixaban at a median of 93 days post-Fontan (7-1421 days). Over a total of 93 days of apixaban exposure, there was 1 treatment-related thrombosis event (0.07 per 1000 person-days on apixaban) and 3 combined treatment-related clinically relevant non-major (CRNM) and major bleeding events (0.22 per 1000 person-days on apixaban). Apixaban for post-Fontan thromboprophylaxis was feasible with low rates of bleeding and thrombosis.

Keywords: Apixaban; Bleeding; Dose; Fontan procedure; Thromboembolism; Thromboprophylaxis.

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Conflict of interest statement

Declarations. Competing Interests: The authors have no competing financial or non-financial interests to declare that are relevant to the content of this article. Ethical Approval: Ethical approval and informed consent were waived by Boston Children’s Hospital IRB in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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