Antithrombotic therapy after bioprosthetic aortic valve replacement: ACTION Registry survey results☆

Colli, Andrea; Verhoye, Jean‐Philippe; Heijmen, Robin H.; Strauch, Justus; Hyde, Jonathan; Pagano, Domenico; Antunes, Manuel J.; Koertke, Heinrich; Ohri, Sunil K.; Bail, D. H. L.; Leprince, Pascal; Straten, Bart H.M. van; Gherli, Tiziano

doi:10.1016/j.ejcts.2007.12.019

Cited by 46 publications

(28 citation statements)

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“…(J Am Coll Cardiol 2012;60:971-7) © 2012 by the American College of Cardiology Foundation Despite having a low long-term risk of thromboembolism, patients treated with aortic valve bioprostheses carry a modest early (Ͻ90 days) risk of embolic events (1). The extent to which this early risk is modifiable has been debated (2)(3)(4), and 2 small randomized trials (n ϭ 268) have failed to demonstrate a benefit of vitamin K antagonism when compared with aspirin (5,6). Nevertheless, the use of antithrombotic agents early after bioprosthetic valve implantation remains common (2,3,7,8).…”

Section: Discussionmentioning

confidence: 99%

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Early Anticoagulation of Bioprosthetic Aortic Valves in Older Patients

Brennan

Edwards

Zhao

et al. 2012

Journal of the American College of Cardiology

132

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Section: Discussionmentioning

confidence: 99%

“…The extent to which this early risk is modifiable has been debated (2)(3)(4), and 2 small randomized trials (n ϭ 268) have failed to demonstrate a benefit of vitamin K antagonism when compared with aspirin (5,6). Nevertheless, the use of antithrombotic agents early after bioprosthetic valve implantation remains common (2,3,7,8).…”

Section: Discussionmentioning

confidence: 99%

Early Anticoagulation of Bioprosthetic Aortic Valves in Older Patients

Brennan

Edwards

Zhao

et al. 2012

Journal of the American College of Cardiology

132

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“…6,7,9,43,45 However, several investigators 46 -48 have questioned the relevance of this recommendation in patients with no thromboembolic risk factors, and according to a recent survey, Ϸ30% of centers use only aspirin during the first 3 months in these patients. 49 After 3 months, warfarin therapy is indicated in patients with a bioprosthesis only if they have Ն1 risk factors for thromboembolism.…”

Section: Long-term Management Antithrombotic Therapymentioning

confidence: 99%

Prosthetic Heart Valves

2009

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“…Although there is a general recommendation (in guidelines) for the utilization of anticoagulation therapy with warfarin in the first 3 months of the postoperative period, especially in the mitral position, there are significant variations of applications between cardiovascular centers around the world (Europe, Middle East, Canada and Asia), including some locations who do not use antithrombotic therapy in this situation [18].…”

Section: Discussionmentioning

confidence: 99%

Impact of aspirin use in the incidence of thromboembolic events after bioprosthesis replacement in patients with rheumatic disease

Durães¹,

Durães²,

Correia³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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Introduction: There is still much debate regarding the kind of antithrombotic therapy in the immediate postoperative period of bioprosthesis replacement (first three months). Thus, the authors consider relevant to determine the contemporary incidence of thromboembolic events in rheumatic patients early after implantation of aortic and mitral bioprosthesis replacement (first 90 days in the post-operative period) and perform a comparison between isolated Aspirin uses versus no-antiplatelet therapy, in this same context. Methods: Between the period of January 2010 to July 2012, all consecutive rheumatic patients, with basal sinus rhythm, who performed mitral and aortic valve replacement with bioprosthesis (pericardial bovine), were included in this prospective cohort study, 184 patients in total. The primary endpoint evaluated were the rate of embolic events.Results: In the first 30 days, there were three cerebral ischemic events among patients treated in Aspirin group (5.2%) compared with two events in patients without Aspirin therapy (1.7%), HR = 3.18; 95% CI 0.5 to 19.6; P=0.33. Between 31 and 90 days postoperatively, no patient had a primary outcome. The embolism-free survival, bleeding events and the overall survival were not statistically significant between the aspirin and no-antiplatelet groups.Conclusion: In conclusion, in this prospective cohort of rheumatic patients, we found a low and very rare incidence rate of embolic events during the first 90 days postoperative period in mitral and isolated aortic position, respectively. The use of aspirin did not significantly reduce the rate of thromboembolism. Descriptors 348Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(3):347-52Durães AR, et al. -Impact of aspirin use in the incidence of thromboembolic events after bioprosthesis replacement in patients with rheumatic disease poor candidates to chronic use of vitamin K antagonist (VKA) [5,6], and were included in this prospective observational single-center cohort study.The main criteria used to classify a patient as a bad candidate to the use of VKA were the place of residence (rural or remote location of a hospital) and low socioeconomic level. The exclusion criteria were previous embolic events or atrial fibrillation, recent cerebral ischemia (6 months), coagulopathy, thrombophilia and allergies to ASA.Preoperative surgical risk was quantified with the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) [7] and the Society of Thoracic Surgeons 2008 cardiac surgery risk model (the STS model) for isolated valve surgery [8].In this cohort, despite being an open study, the investigators did not have any influence on the postoperative administration of ASA. Of three surgical teams that performed the surgical procedures, only one recommended the routine use of ASA in this context, and the other two teams opted not to use it. The selection of the surgical team for each patient always followed a computerized electronic scheduling, and this system, through a ...

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Antithrombotic therapy after bioprosthetic aortic valve replacement: ACTION Registry survey results☆

Abstract: This study demonstrates that, despite guidelines published by several professional societies, medical practice for the prevention of thrombotic events early after bioprosthetic AVR varies widely among cardiac surgical centers.

Cited by 46 publications

References 20 publications

Early Anticoagulation of Bioprosthetic Aortic Valves in Older Patients

Early Anticoagulation of Bioprosthetic Aortic Valves in Older Patients

Prosthetic Heart Valves

Impact of aspirin use in the incidence of thromboembolic events after bioprosthesis replacement in patients with rheumatic disease

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