{"doi":"10.1016/j.rpth.2025.103161","title":"Antithrombotic strategies and outcomes in neonates and infants with cardiac shunts: a systematic review and meta-analysis","abstract":"<h2>ABSTRACT</h2><h3>Background</h3> Cardiac shunt thrombosis in neonates and infants remains a concern for shunt failure and mortality. The optimal strategy for thromboprophylaxis remains unknown. This systematic review aims to characterize antithrombotic strategies and outcomes in neonates and infants with a cardiac shunt. <h3>Methods</h3> MEDLINE, Embase, and Cochrane's CENTRAL were searched from inception through July 2024 for studies reporting shunt thrombosis prevalence among infants who received a cardiac shunt. We estimated the pooled prevalence of shunt thrombosis using random-effects meta-analysis. In the subgroup analysis, we evaluated the effects of shunt type and antithrombotic strategies on shunt thrombosis prevalence. <h3>Results</h3> A total of 39 studies (29 retrospective, 10 prospective) were included, totaling 4735 patients. The most common shunt type was the modified Blalock-Taussig (mBTTS) (n=2224, 47%). Mortality related to shunt thrombosis occurred in 102 (26.2%) of patients with shunt thrombosis. The most common antithrombotic agents in the acute post-op setting were unfractionated heparin (UFH, n=1452, 30.7%) or aspirin (n=1413, 29.3%). The pooled prevalence of shunt thrombosis was 8.4% (95% Confidence Interval [CI], 6.5%-10.4%) and varied among antithrombotic agents: aspirin: 7.4% (95% CI, 4.0%-11.4%), UFH: 3.8% (95% CI, 0%-12.3%), or UFH followed by aspirin: 6.3% (95% CI, 3.6%-9.4%). <h3>Conclusions</h3> This systematic review of nearly 5,000 neonates and infants reveals a high rate of mortality associated with shunt thrombosis. Collaborative prospective studies are warranted to evaluate antithrombotic regimen-outcome relationships and prognostic factors for shunt thrombosis and bleeding outcomes in these children.","journal":"Research and Practice in Thrombosis and Haemostasis","year":2025,"id":526667,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9629,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":468165,"name":"Neil A. 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Nhue","orcid":"0000-0003-2731-7414","position":9,"is_corresponding":false},{"id":1118408,"name":"Dalia Bashir","orcid":"0000-0002-8816-9059","position":10,"is_corresponding":false},{"id":1402775,"name":"Kisha Beg","orcid":null,"position":11,"is_corresponding":false},{"id":1402776,"name":"Victor Benvenuto","orcid":null,"position":12,"is_corresponding":false},{"id":1006927,"name":"Rukhmi Bhat","orcid":"0000-0002-1700-4804","position":14,"is_corresponding":false},{"id":1402777,"name":"Joshua Branstetter","orcid":null,"position":15,"is_corresponding":false},{"id":486745,"name":"Paul Davies","orcid":"0000-0002-3973-3143","position":16,"is_corresponding":false},{"id":1402778,"name":"Nhue Do","orcid":null,"position":17,"is_corresponding":false},{"id":1402779,"name":"Kate Garland","orcid":null,"position":18,"is_corresponding":false},{"id":1402780,"name":"Therese Giglia","orcid":null,"position":19,"is_corresponding":false},{"id":1208175,"name":"Neil Goldenberg","orcid":null,"position":20,"is_corresponding":false},{"id":1402781,"name":"Amy Kiskaddon","orcid":null,"position":21,"is_corresponding":false},{"id":1402782,"name":"Joel Livingston","orcid":null,"position":22,"is_corresponding":false},{"id":467327,"name":"Christoph Male","orcid":"0000-0002-4989-6421","position":23,"is_corresponding":false},{"id":645278,"name":"Paul Monagle","orcid":null,"position":24,"is_corresponding":false},{"id":510026,"name":"Jun Teruya","orcid":"0000-0002-6124-803X","position":27,"is_corresponding":false},{"id":1272254,"name":"Gary Woods","orcid":"0000-0002-0921-0974","position":28,"is_corresponding":false},{"id":1402774,"name":"Amy L. 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