Heart valve prosthesis unquestionably improve quality of life and survival of
patients with severe valvular heart disease, but the need for antithrombotic therapy
to prevent thromboembolic complications is a major challenge to clinicians and their
patients. Of the articles analyzed, most were retrospective series of cases or
historical cohorts obtained from the database. The few published randomized trials
showed no statistical power to assess the primary outcome of death or thromboembolic
event. In this article, we decided to perform a systematic literature review, in an
attempt to answer the following question: what is the best antithrombotic strategy in
the first three months after bioprosthetic heart valve implantation (mitral and
aortic)?After two reviewers applying the extraction criteria, we found 1968 references,
selecting 31 references (excluding papers truncated, which combined bioprosthesis
with mechanical prosthesis, or without follow-up).Based on this literature review, there was a low level of evidence for any
antithrombotic therapeutic strategy evaluated. It´s therefore interesting to use
aspirin 75 to 100 mg / day as antithrombotic strategy after bioprosthesis replacement
in the aortic position, regardless of etiology, for patients without other risk
factors such as atrial fibrillation or previous thromboembolic event. In the mitral
position, the risk of embolism, although low, is more relevant than in the aortic
position, according to published series and retrospective cohorts comprised mostly of
elderly non-rheumatic patients.The current evidence is limited to have a consistent and safe level of evidence
regarding the best therapeutic strategy. Based on these studies, 75 to 100 mg/day of
aspirin is interesting as antithrombotic strategy after implantation of aortic
bioprosthesis, regardless of etiology, for patients with no other risk factors such
as atrial fibrillation or previous thromboembolic event. As for mitral bioprosthesis,
the risk of embolism, although low, is more relevant than in the aortic position,
according to published series and retrospective cohorts - usually elderly non
rheumatic patients.