School of Medicine and Health Sciences Poster Presentations

Poster Number

180

Document Type

Poster

Keywords

adenotonsillectomy; Fontan repair; aspirin cessation

Publication Date

3-2016

Abstract

Objective: Pediatric patients who have undergone the Fontan procedure are often on a long term aspirin regimen which can complicate perioperative management. In high risk procedures such as adenotonsillectomy, hemorrhage can be a significant complication and aspirin use may increase the risk. There is a need for evidence-based protocol on how to manage aspirin intake in the perioperative period for Fontan patients. We report the case of a patient with Fontan palliation who underwent adenotonsillectomy and presented with postoperative hemorrhage.

Methods: PubMed was searched for guidelines, case reports, and reviews on pediatric Fontan patients, adenotonsillectomy, and perioperative aspirin cessation.

Results: Current literature lacks a consensus on perioperative management of aspirin for patients on a long term aspirin regimen. Pediatric patients who have undergone the Fontan procedure are at an increased risk of thrombosis which suggests that aspirin should be continued perioperatively, except during high risk procedures where there is increased risk of hemorrhage. Hemorrhage is a significant but uncommon complication of adenotonsillectomy and does not appear to be increased in high-risk patients with comorbid conditions. However, there is need for more updated evidence-based literature on aspirin and bleeding complications following adenotonsillectomy.

Conclusion: The current literature does not offer guidance regarding the ideal perioperative management of aspirin for patients with aspirin dependent cardiac conditions, such as those status post Fontan repair. Retrospective evaluation of current management and prospective protocols should be studied to aid in the management of this growing population.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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Perioperative Aspirin Recommendations in Children with Fenestrated Fontan Undergoing Adenotonsillectomy

Objective: Pediatric patients who have undergone the Fontan procedure are often on a long term aspirin regimen which can complicate perioperative management. In high risk procedures such as adenotonsillectomy, hemorrhage can be a significant complication and aspirin use may increase the risk. There is a need for evidence-based protocol on how to manage aspirin intake in the perioperative period for Fontan patients. We report the case of a patient with Fontan palliation who underwent adenotonsillectomy and presented with postoperative hemorrhage.

Methods: PubMed was searched for guidelines, case reports, and reviews on pediatric Fontan patients, adenotonsillectomy, and perioperative aspirin cessation.

Results: Current literature lacks a consensus on perioperative management of aspirin for patients on a long term aspirin regimen. Pediatric patients who have undergone the Fontan procedure are at an increased risk of thrombosis which suggests that aspirin should be continued perioperatively, except during high risk procedures where there is increased risk of hemorrhage. Hemorrhage is a significant but uncommon complication of adenotonsillectomy and does not appear to be increased in high-risk patients with comorbid conditions. However, there is need for more updated evidence-based literature on aspirin and bleeding complications following adenotonsillectomy.

Conclusion: The current literature does not offer guidance regarding the ideal perioperative management of aspirin for patients with aspirin dependent cardiac conditions, such as those status post Fontan repair. Retrospective evaluation of current management and prospective protocols should be studied to aid in the management of this growing population.

 

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