Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement

Abstract

New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

“…In surgery and transcutaneous procedures, a vascular closure device is safe to use and allows for the percutaneous cannulation of the femoral vessels [ 40 ]. Verstraete et al in 2021 provided a useful review with a variety of considerations for antithrombotic treatment after surgery and transcutaneous procedures [ 41 , 42 ]. The use of direct oral anticoagulants (DOACs) is the subject of ongoing studies, although occasional studies have shown MIMVS to have promising results [ 43 ].…”

A successful double valve repair on an interesting background: Case report

“…Moreover, Observational studies suggest that VKAs are not superior to low‐dose aspirin regarding thromboembolic prevention after mitral valve repair, but potentially increase the risk of bleeding. After aortic valve repair, low‐dose aspirin can be considered as per current recommendations 10 …”

The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective study

“…Although these patients were included in multiple groups, the presence of combination therapy was included as a potential confounder in the regression models to account for this. The initiation and duration of treatment with antithrombotic therapies in the PVE group at our center has been published prevoiusly 13 ; details are given in the Appendix E1 .…”

“…Some patients received 2 or more antithrombotic therapies; these are summarized in Table E2. Although these patients were included in multiple groups, the presence of combination therapy was included as a potential confounder in the 13 ; details are given in the Appendix E1.…”