Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue

Colli, Andrea; Verhoye, Jean‐Philippe; Leguerrier, Alain; Gherli, Tiziano

doi:10.1016/j.ejcts.2007.02.002

Cited by 21 publications

(11 citation statements)

References 42 publications

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“…2007 [36]). Thus, although the low blood element damage observed for BHVs correlates well with the low rates of thromboembolic events reported from clinical use (2,37), a precise antithrombotic protocol after BHV replacement remains to be developed (36).…”

Section: Discussionmentioning

confidence: 99%

“…Functional status, thromboembolic events, and survival were not adversely affected by withholding any antiplatelet therapy (35). However, the international official guidelines, issued by organizations such as AHA/ ACC, the Canadian Cardiovascular Society, and the British Society of Hematology, recommend longterm ASA for patients with BHV in absence of risk factors (see Table 1 of Colli et al 2007 [36]). Thus, although the low blood element damage observed for BHVs correlates well with the low rates of thromboembolic events reported from clinical use (2,37), a precise antithrombotic protocol after BHV replacement remains to be developed (36).…”

Section: Blood Element Damagementioning

confidence: 99%

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Computational Evaluation of Platelet Activation Induced by a Bioprosthetic Heart Valve

Sirois

Sun

2010

Artificial Organs

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It is known that bioprosthetic heart valves (BHVs) have better hemodynamics and lower thromboembolic events compared with their mechanical counterparts; however, patients implanted with BHVs still face the potential of such complications. The risk of a clinical thromboembolism is on average 0.7% per year in patients with tissue valves in sinus rhythm. In this study, we developed a computational fluid dynamic (CFD) model of a BHV implanted in an aortic root and investigated the BHV-induced platelet activation using a damage accumulation model previously applied to mechanical valves. The CFD model was validated against published experimental data, including the flow velocity profile across the valve and the transvalvular pressure drop, and close matches were obtained. Hemodynamic performance measures such as flow velocity, turbulent kinetic energy, and wall shear stress were explored. Lagrangian particle tracking was used to calculate the extent of platelet activation for central bulk flow and flow in the vicinity of the leaflets. A peak flow of 2.22 m/s was observed at 40 msec after peak systole in the vicinity of a fold at the base of the leaflets. With the platelet activation expressed as 0-100% of activation threshold levels, mean damage on one pass was 2.489 × 10(-7)% and maximum damage on one pass was 8.778 × 10(-4)%. Our results suggested that the potential for BHV-induced platelet activation was low and that the leaflet's fully open geometry might play a role in the extent of blood element damage.

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Section: Discussionmentioning

confidence: 99%

Section: Blood Element Damagementioning

confidence: 99%

Computational Evaluation of Platelet Activation Induced by a Bioprosthetic Heart Valve

Sirois

Sun

2010

Artificial Organs

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“…De acuerdo a nuestra experiencia institucional, se sabía que el porcentaje de adherencia a esta recomendación sería baja entre cardiólogos del Instituto Nacional de Cardiología Ignacio Chávez de la Ciudad de México. Como se mencionó anteriormente, en encuestas internacionales previas 8,9 , se encontró que un muy bajo porcentaje de médicos (16%) seguían la recomendación de utilizar un AVK en el postoperatorio e incluso hasta el 22% no utilizaban terapia antitrombótica aguda. En este estudio encontramos que solo en el 10% de los casos se siguió la recomendación de la ACC/AHA de 2014 de anticoagular formalmente durante los primeros 3 meses además de aspirina de por vida, un número muy cercano a la información previamente presentada.…”

Section: Discussionunclassified

“…Recomendaciones de guías actualesOrganización, año Recomendación Evidencia ESC, 2012 Aspirina a dosis bajas debe ser considerada en los primeros 3 meses posteriores a la implantación de una prótesis biológica en posición aórtica 2C ACC/AHA, 2014 Aspirina 75-100 mg al día es razonable en todos los pacientes con una prótesis biológica en posición aórtica. Anticoagulación con un antagonista de vitamina K para mantener un INR de 2.5 puede ser también razonable durante los primeros 3 meses posteriores al cambio valvular europeos administran únicamente ASA en el postoperatorio temprano, sin anticoagulantes orales9 .Múltiples estudios, la mayoría de ellos retrospectivos y observacionales, han comparado la incidencia de eventos trombóticos y complicaciones hemorrágicas entre el…”

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Evaluación de la estrategia de terapia antitrombótica posterior al cambio valvular aórtico con válvulas biológicas en pacientes de bajo riesgo trombótico

Aceves-Velázquez

Vieyra-Herrera

Rodríguez-Chávez

et al. 2018

Archivos de Cardiología de México

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According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period.

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“…The British Society of Haematology does not recommend the use of vitamin K antagonists for the first 3 months after AVR if patients are in sinus rhythm, although it does not contraindicate the prescription of vitamin K antagonists [36] . Colli et al [37] investigated the outcome of different anticoagulation and/or antiplatelet therapies in bioprosthetic heart valve recipients. In summary, this review showed that in patients without thromboembolic risk factors, antiplatelet therapy as antithrombotic protection during the early postoperative period after AVR with a bioprosthesis is sufficient.…”

Section: Anticoagulation or Antiplatelet Therapy Of Bioprosthetic Heamentioning

confidence: 99%

The Elderly Patient and Cardiac Surgery – A Mini-Review

Wiedemann

Bernhard²,

Laufer³

et al. 2009

Gerontology

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Introduction: Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care mean that more elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery and surgery of the ascending aorta are performed in elderly patients. Objective: In this review, we summarize the outcome of elderly patients undergoing various cardiac surgical procedures and give future perspectives for the treatment of elderly patients with cardiac surgery. Methods: A PubMed search for the period from 1980 to February 2009 was conducted with the following key words: ‘elderly patient’, ‘cardiac surgery’, ‘CABG aortic surgery’, ‘mitral valve surgery’ and ‘endocarditis’. Additional information concerning population demographics was obtained from the World Health Organization homepage. Results: More and more cardiac surgical procedures are offered to elderly patients. The short- and long-term survival rates of elderly patients are comparable to those of younger patients. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease and a poor clinical state are associated with a worse outcome in elderly patients. Conclusion: The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia and myoacardial protection are basic requirements for the success of cardiac surgery in elderly patients.

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Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue

Cited by 21 publications

References 42 publications

Computational Evaluation of Platelet Activation Induced by a Bioprosthetic Heart Valve

Computational Evaluation of Platelet Activation Induced by a Bioprosthetic Heart Valve

Evaluación de la estrategia de terapia antitrombótica posterior al cambio valvular aórtico con válvulas biológicas en pacientes de bajo riesgo trombótico

The Elderly Patient and Cardiac Surgery – A Mini-Review

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