Nonusefulness of Antithrombotic Therapy After Surgical Bioprosthetic Aortic Valve Replacement - 24/07/20
Highlights |
• | The risk of embolic events is low in patients receiving bioprosthetic aortic valve. |
• | Antithrombotic agents showed no difference in survival and thromboembolic events. |
• | Antiplatelet therapy demonstrates benefit in coronary artery disease patients post aortic valve replacement. |
• | Atrial fibrillation regardless of therapy, increased the odds of adverse events. |
• | Anticoagulation after biological aortic valve replacement is unnecessary and potentially harmful. |
Résumé |
Controversy persists regarding the advisability of anticoagulation for the early period after biological surgical aortic valve replacement (AVR). We aim to examine the impact of various antithrombotic regimens on outcomes in a large cohort of biological AVR patients.
Records of 1,111 consecutive adult patients who underwent surgical biological AVR at our institution between 2013 and 2017 were reviewed. Outcomes included stroke, bleeding, and death at 3 and 12 months. Treatment regimens included (1) no therapy, (2) anticoagulants (warfarin or Factor Xa inhibitors), (2) antiplateles (various), and (4) anticoagulants + antiplatelets. Kaplan-Meier analysis was used to track outcomes, and Cox-proportional hazards regression models were conducted to analyze effects of different therapies on adverse events.
At 3 months, thromboembolic events were low and not significantly different between the no therapy group (2.2%) and anticoagulation (2.8%) or anticoagulation + antiplatelet (3.6%) or all groups (3.7%). The antiplatelet group was just significantly lower, at 2.2%. However, this was driven by non-stroke cardiovascular events in patients with coronary artery disease. The incidence of death at 3 months was low and not significantly different between all groups. At 12 months, there were no thromboembolic benefits between groups, but bleeding events were significantly higher in the anticoagulation group (no therapy (1.4%), anticoagulation (8.4%), antiplatelet (4.5%), anticoagulation + antiplatelet (7.9%)). In conclusion, none of the antithrombotic regimens showed benefits in stroke or survival at 3 or 12 months after biological AVR. Anticoagulation increased bleeding events. Routine anticoagulation after biological AVR appears to be unnecessary and potentially harmful.
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| Sources of Funding: None |
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| Authors’ Conflict of Interest: None relevant to the current study. Dr. John Elefteriades sits on the Data and Safety Monitoring Boards of Terumo and Jarvik Heart and is a principal of CoolSpine. |
Vol 129
P. 71-78 - août 2020 Retour au numéro
Article précédent
- Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ?85 Years Versus Those <85 Years
- Martino Pepe, Nicola Corcione, Giuseppe Biondi-Zoccai, Alberto Morello, Sergio Berti, Francesco Bedogni, Alessandro Iadanza, Fabrizio Tomai, Gennaro Sardella, Enrico Romagnoli, Paolo Ferraro, Sirio Conte, Palma Luisa Nestola, Marcello De Giosa, Michele Cimmino, Giacomo Frati, Arturo Giordano
- Prognostic Impact of Underweight (Body Mass Index <20 kg/m2) in Patients With Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement (from the German Aortic Valve Registry [GARY])
- Lisa Voigtländer, Raphael Twerenbold, Ulrich Schäfer, Lenard Conradi, Ümniye Balaban, Raffi Bekeredjian, Stephan Ensminger, Thomas Walther, Andreas Beckmann, Christian Frerker, Timm Bauer, Christian Hamm, Helge Möllmann, Sabine Bleiziffer, GARY Executive Board
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