The Fontan patient: inconsistencies in medication therapy across seven pediatric heart network centers.
The Fontan patient: inconsistencies in medication therapy across seven pediatric heart network centers.
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DOI：
10.1007/s00246-010-9807-5
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发表时间：
2010-11
影响因子：
1.6
通讯作者：
Williams, Richard V.
中科院分区：
文献类型：
--
作者：
Anderson, Page A. W.;Breitbart, Roger E.;McCrindle, Brian W.;Sleeper, Lynn A.;Atz, Andrew M.;Hsu, Daphne T.;Lu, Minmin;Margossian, Renee;Williams, Richard V.
接受Fontan手术的患者存在血栓形成、心室功能障碍和瓣膜返流的风险，但缺乏指导该人群中这些不良结局的药物治疗和预防的数据。该分析按假定适应症和研究中心检查了Fontan患者的药物使用情况。在儿科心脏网络多中心横断面研究中评估了546例6-18岁Fontan受试者的病史和当前用药。在入组后3个月内进行心脏成像。大多数受试者（64%）正在服用两种或多种药物。86%有中风史、血栓形成史或两者兼有史的患者服用抗血栓药物，67%无此类病史的患者服用抗血栓药物（P = 0.01）。相反，14%有中风、血栓形成或两者兼有病史的患者没有服用抗血栓药物。血管紧张素转换酶抑制剂（ACEi）治疗与中度或重度房室瓣反流（P = 0.004）、右心室形态（P < 0.001）和Fontan后较短时间（P = 0.004）独立相关，但与心室收缩功能障碍无关。糖苷类治疗和利尿剂治疗均与Fontan年龄较大（分别为P = 0.001和P = 0.023）和Fontan术后心律失常史（分别为P < 0.001和P = 0.003）相关，但与心室收缩功能障碍无关。各中心的药物使用率差异很大，即使控制了患者特征的中心差异。需要前瞻性治疗试验来指导Fontan患者的药物治疗。
Patients who have undergone the Fontan procedure are at risk for thrombosis, ventricular dysfunction, and valve regurgitation, but data to guide the medical treatment and prevention of these adverse outcomes in this population are lacking. This analysis examined medication usage among Fontan patients by putative indication and by study center. The medical history and current medications of 546 Fontan subjects, ages 6–18 years, were assessed in a Pediatric Heart Network multicenter cross-sectional study. Cardiac imaging was performed within 3 months of enrollment. The majority of the subjects (64%) were taking two or more medications. Antithrombotics were taken by 86% of those with a history of stroke, thrombosis, or both and 67% of those without such a history (P = 0.01). Conversely, 14% of those with a history of stroke, thrombosis, or both were taking no antithrombotic. Angiotensin-converting enzyme inhibitor (ACEi) therapy was independently associated with moderate or severe atrioventricular valve regurgitation (P = 0.004), right ventricular morphology (P < 0.001), and shorter time since Fontan (P = 0.004) but not with ventricular systolic dysfunction. Glycoside therapy and diuretic therapy each was associated with older age at Fontan (P = 0.001 and P = 0.023, respectively) and a history of post-Fontan arrhythmia (P < 0.001 and P = 0.003, respectively) but not with ventricular systolic dysfunction. Medication use rates varied widely among the centers, even with controls for center differences in patient characteristics. Prospective therapeutic trials are needed to guide the medical treatment of Fontan patients.
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影响因子：
37.8
作者：
Khairy, Paul;Fernandes, Susan M.;Landzberg, Michael J.
通讯作者：
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影响因子：
37.8
作者：
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通讯作者：
HELLENBRAND, WE
DOI：
10.1016/s0022-5223(98)70311-3
发表时间：
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作者：
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