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Pediatric Cardiology

, Volume 40, Issue 1, pp 53–60 | Cite as

Variation in Anticoagulation Practices in the Congenital Cardiac Catheterization Lab: Results of a Multinational PICES Survey

  • Nathaniel W. TaggartEmail author
  • Brent M. Gordon
  • Gareth J. Morgan
  • Bryan H. Goldstein
Original Article

Abstract

The complex nature of congenital heart disease (CHD) has hindered the establishment of management standards for peri-catheterization anticoagulation. We sought to describe anticoagulation practice variability among providers performing cardiac catheterization in children and adults with CHD. A web-based survey (http://www.surveymonkey.com) was distributed to pediatric and congenital interventional cardiologists. Respondents were queried on their training, practice setting, years in practice, and case volume. Clinical questions focused on general anticoagulation strategies and on five common clinical scenarios: two diagnostic (biventricular circulation, single ventricle physiology) and three interventional cardiac catheterizations (atrial septal defect closure, pulmonary artery stenting in Fontan circulation, stent placement for coarctation of aorta). Seventy-seven pediatric and congenital interventional cardiologists responded to the survey (81% in the United States). Twenty-six (36%) worked in a public medical institution; 57% worked in a free-standing children’s hospital. Twenty-six percent had been in practice for < 5 years and 32% for > 15 years; 75% completed additional training in interventional congenital cardiology. The median number of cases performed was 200/year (IQR 110); median number of interventional cases was 100/year (IQR 100). Responses to general queries and specific clinical scenarios suggested significant variation in anticoagulation practices, including monitoring of anticoagulation during catheterization, protamine use, and outpatient anticoagulation after catheterization. Practices not only varied between providers but also between different clinical scenarios. Practice patterns did not correlate with provider experience or case volume. Management of anticoagulation in the congenital cardiac catheterization lab varies from operator to operator. Our study may provide some initial insight and context for discussion regarding anticoagulation in a field of increasingly heterogeneous interventional techniques and patient substrates. Future studies would be helpful to better define “best practices” for peri-procedural thromboprophylaxis in patients with congenital heart disease.

Keywords

Survey Cardiac catheterization Anticoagulation Quality improvement 

Notes

Author Contributions

NWT contributed to the concept and design of this study; data collection, analysis and interpretation; drafting and critical revision of the article; statistical analysis; and final approval of the manuscript. BHG, BMG, and GJM contributed to the concept and design of this study; data analysis and interpretation; critical revision of the article; and final approval of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors have no financial or other conflicts of interest related to this study.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

246_2018_1960_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nathaniel W. Taggart
    • 1
    Email author
  • Brent M. Gordon
    • 2
  • Gareth J. Morgan
    • 3
  • Bryan H. Goldstein
    • 4
  1. 1.Division of Pediatric Cardiology, Department of Pediatric and Adolescent MedicineMayo ClinicRochesterUSA
  2. 2.Division of Pediatric CardiologyLoma Linda University Children’s HospitalLoma LindaUSA
  3. 3.Department of Paediatric CardiologyEvelina Children’s Hospital, Guy’s and St. Thomas’ NHS TrustLondonUK
  4. 4.Division of Cardiology, The Heart InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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