Guidelines for prevention of thromboembolic events in valvular heart disease

Gohlke-Bärwolf, Ch.; Acar, J; Oakley, Celia M.; Butchart, Eric G.; Burckhart, D; Bodnár, E; Hall, Roger; Delahaye, J P; Horstkotte, Dieter; Kremer, René

doi:10.1093/oxfordjournals.eurheartj.a060739

Cited by 149 publications

(30 citation statements)

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“…This gives physiological support to the widespread clinical practice 6,7 of not prescribing oral anticoagulation for a period of 3 months postoperatively to patients who are otherwise at low risk for thromboembolism after bAVR, in contrast to the guidelines that are currently in effect. 3,4,5 Indeed, using high-dose aspirin only in the early postoperative period to prevent cerebral embolization appears safe and mechanistically supported by the present data, while not presenting the added bleeding risk associated with warfarin use. 8 Interestingly, despite the fact that no clinical neurological events (stroke, transient ischemic attacks) were detected possibly due to the small number of patients in the study, there was a high proportion of patients with recorded MES in both groups (46% and 43% at 1 month).…”

Section: Discussionsupporting

confidence: 74%

“…1 Although long-term results show a low incidence of thromboembolic complications, the first 3 postoperative months are considered a higher risk period for thromboemboli formation, due to the incomplete endothelialization of the sewing ring. 2 The guidelines of the American College of Cardiology/American Heart Association, 3 European Society of Cardiology, 4 and American College of Chest Physicians 5 indicate that patients undergoing bioprosthetic aortic valve replacement (bAVR) should be managed with warfarin to maintain an INR between 2.0 and 3.0 during the first 3 postoperative months, followed by daily low-dose aspirin. Although surgeons were initially supportive of these recommendations, 5 recent clinical surveys suggest that only 17% of cardiac surgeons follow these guidelines after bAVR.…”

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confidence: 99%

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Cerebral Microembolization After Bioprosthetic Aortic Valve Replacement

Al-Atassi

Lam²,

Forgie³

et al. 2012

Circulation

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Background-No human physiological data exists on whether aspirin only is as effective as warfarin plus aspirin in preventing cerebral microembolization in the early postoperative period after bioprosthetic aortic valve replacement (bAVR). Methods and Results-We prospectively enrolled 56 patients who had no other indication for oral anticoagulation, who underwent bAVR and received, in an open-label fashion, either daily warfarin (for INR 2.0 -3.0) plus 81 mg of aspirin (nϭ28) or 325 mg of aspirin only (nϭ28). Cerebral microembolization was quantified at 4 hours (baseline) and at 1 month postoperatively, by recording 1-hour bilateral middle cerebral artery (MCA) microembolic signals (MES). Platelet-function analysis (PFA) of closure times (CT) on collagen was also used as a marker of platelet-dependent activation. Follow-up to 1 year was complete. Preoperative demographics and baseline platelet function were equivalent in both groups. There was no mortality, stroke, or transient ischemic attack at 1 year in either group. No significant differences were found in the proportion of patients with MES among those receiving warfarin plus aspirin versus aspirin only, at baseline (68% versus 82%, respectively; Pϭ0.4) and at 1 month (46% versus 43%; Pϭ1.0) after bAVR. The total MES and PFA were also equivalent between groups, at baseline and follow-up. Conclusions-Early after bAVR, the effects of these 2 antithrombotic regimens on cerebral microembolization and platelet function are equivalent. These data bring new mechanistic support to the premise that aspirin only may safely be used early after bAVR in patients who have no other indication for oral anticoagulation.

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Section: Discussionsupporting

confidence: 74%

mentioning

confidence: 99%

Cerebral Microembolization After Bioprosthetic Aortic Valve Replacement

Al-Atassi

Lam²,

Forgie³

et al. 2012

Circulation

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“…Its thrombocytopenia (48) and osteopenia (49) risks are less compared to unfractionated heparin and it appears to be safe for the fetus as well (50) . It can't be recommended to the patients with mechanical valves currently because there aren't enough studies performed yet (20,51) .…”

Section: Pregnancy In Woman With Valve Prosthesismentioning

confidence: 99%

Valvular Diseases in Pregnancy

Parlakgumus¹,

Bağış²,

Haydardedeoğlu³

2011

J Turk Soc Obstet Gynecol

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“…Depending on in patients with atrial fibrillation associated with heart valve disease (e.g. rheumatic); heart valve prosthesis, associated risk factors, individual patients with atrial fibrillation could thus be considered as high, moderate heart failure, intracardiac thrombus, or thyrotoxicosis [53][54][55]. On this evidence, as well as the evidence for or low risk for stroke and thromboembolism [52].…”

Section: Introductionmentioning

confidence: 99%

Warfarin and aspirin as thromboprophylaxis in atrial fibrillation

Lip

Lowe

1996

Brit J Clinical Pharma

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1Anticoagulant therapy with warfarin is now established as effective thromboprophylaxis against stroke in atrial fibrillation, in high‐risk persons. Aspirin is indicated in moderate‐risk persons or if warfarin is contraindicated. 2Risk stratification is suggested, using clinical factors supplemented by echocardiography, to aid choice of prophylaxis. 3Further studies are required to establish how best to identify undiagnosed patients who have atrial fibrillation; to develop new therapeutic strategies; and to refine risk stratification to define which patients with atrial fibrillation are at the highest risk of stroke.

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Guidelines for prevention of thromboembolic events in valvular heart disease

Cited by 149 publications

References 0 publications

Cerebral Microembolization After Bioprosthetic Aortic Valve Replacement

Cerebral Microembolization After Bioprosthetic Aortic Valve Replacement

Valvular Diseases in Pregnancy

Warfarin and aspirin as thromboprophylaxis in atrial fibrillation

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