Antithrombotic treatment for valve prostheses: Which drug, which dose, and when?

Ricottini, Elisabetta; Nusca, Annunziata; Grigioni, Francesco

doi:10.1016/j.pcad.2022.05.008

Cited by 4 publications

(3 citation statements)

References 81 publications

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“…As such, this type of valve prostheses has been associated with reduced rates of PPM, even in patients with small aortic annuli 60,61 . Moreover, some of the newer generation bileaflet mechanical valves are associated with very low incidence of thrombotic events and have been approved in use with lower INR targets [62][63][64] . The Sorin Bicarbon Overline (currently manufactured by Corcym, Corcym UK Limited, London, United Kingdom) is one of them and offers even better EOA in a supra-annular position 65 .…”

Section: Aortic Root Enlargement (Are) and Other Techniquesmentioning

confidence: 99%

Aortic patient-prosthesis mismatch - does it matter? A review for cardiologists and cardiac surgeons

Visan,

Zlibut,

Ionescu

et al. 2024

Romanian Journal of Cardiology

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Patient-prosthesis mismatch (PPM) is the situation in which the area of an artificial valve is smaller than that of a healthy native valve it replaces. By this definition, all artificial valves demonstrate PPM, but large observational studies and several meta-analyses suggest that it is present in 30-50% of patients after surgical aortic valve replacement (SAVR). PPM has an impact on outcomes only when the indexed aortic valve area (AVAi) is ≤0.85cm2/m2 (moderate PPM) or 0.65cm2/m2 (severe PPM), particularly in patients with reduced LVEF. In transcatheter aortic valve replacement, the prevalence of PPM may be as low as 0.1%, and its impact on hard outcomes is not clear. We present a review of the relevant literature together with a framework for the differential diagnosis of increased pressure gradient and reduced area in prosthetic aortic valves and different strategies to reduce the risk of PPM with SAVR.

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Section: Aortic Root Enlargement (Are) and Other Techniquesmentioning

confidence: 99%

Aortic patient-prosthesis mismatch - does it matter? A review for cardiologists and cardiac surgeons

Visan,

Zlibut,

Ionescu

et al. 2024

Romanian Journal of Cardiology

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“…As explained by Ricottini et al (14), it is challenging to put patients with TAVI and bioprosthetic heart valves under one group. In patients with bioprosthetic heart valves, the traditional indication to VKAs is for at least 3 months based on the estimated time needed for the endothelisation of the cloth sewing ring.…”

Section: The Intervention and The Position Of The Bioprosthetic Valvementioning

confidence: 99%

Safety and efficacy of direct oral anticoagulants in bioprosthetic valves: A systematic review and meta-analysis

Bakr

Elsayed²,

Saleh³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundDirect oral anticoagulants are efficient alternatives to vitamin K antagonists. There is little evidence regarding their use in patients who underwent bioprosthetic valve replacement whether surgically or through a transcatheter approach and have another indication of anticoagulation. Trials have compared different members of the DOACs family to VKAs and showed that they were at least non-inferior to VKAs with regard to safety and efficacy. However, this is still controversial. Our meta-analysis aims at providing a clearer view of their future use in this subgroup of patients.MethodsPubMed and Cochrane were searched for randomised clinical trials and observational studies. Bleeding, stroke, and all-cause mortality were the outcomes of interest.ResultsTen papers with a total of 4,088 patients were included. Our meta-analysis revealed no significant differences between the incidence of bleeding between DOACs and warfarin (16% vs. 17%, OR = 0.94, 95% CI [0.56–1.57], p = 0.81, I2 = 81%). No statistical difference was found in stroke between both groups (2.5% vs. 3.3%, OR = 0.75, 95% CI [0.41–1.38], p = 0.36, I2 = 35%). All-cause mortality was not statistically significant between both groups (9.2% vs. 13.7%, OR = 0.85, 95% CI [0.68–1.07], p = 0.16, I2 = 56%). Interestingly, subgroup analysis of randomised controlled trials and prospective studies favoured DOACs with lower risks of both bleeding and stroke.ConclusionDirect oral anticoagulants appear to be at least as safe and effective as VKAs in patients with bioprosthetic valves and another indication of anticoagulation. There could be potential benefit from the use of DOACs; however, further evidence is required.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222146, identifier CRD42021222146.

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“…DOACs are associated with a lower risk of systemic thromboembolic events and intracranial hemorrhage. Additionally, in the case of excessive anticoagulation, DOACs-induced bleeding can be reversed ( 191 , 192 ). However, DOACs are not a universally accepted approach because of their high price.…”

Section: Treatment Strategymentioning

confidence: 99%

Pathophysiological mechanisms of thrombosis in acute and long COVID-19

Jing

Xiang

et al. 2022

Front. Immunol.

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COVID-19 patients have a high incidence of thrombosis, and thromboembolic complications are associated with severe COVID-19 and high mortality. COVID-19 disease is associated with a hyper-inflammatory response (cytokine storm) mediated by the immune system. However, the role of the inflammatory response in thrombosis remains incompletely understood. In this review, we investigate the crosstalk between inflammation and thrombosis in the context of COVID-19, focusing on the contributions of inflammation to the pathogenesis of thrombosis, and propose combined use of anti-inflammatory and anticoagulant therapeutics. Under inflammatory conditions, the interactions between neutrophils and platelets, platelet activation, monocyte tissue factor expression, microparticle release, and phosphatidylserine (PS) externalization as well as complement activation are collectively involved in immune-thrombosis. Inflammation results in the activation and apoptosis of blood cells, leading to microparticle release and PS externalization on blood cells and microparticles, which significantly enhances the catalytic efficiency of the tenase and prothrombinase complexes, and promotes thrombin-mediated fibrin generation and local blood clot formation. Given the risk of thrombosis in the COVID-19, the importance of antithrombotic therapies has been generally recognized, but certain deficiencies and treatment gaps in remain. Antiplatelet drugs are not in combination with anticoagulant treatments, thus fail to dampen platelet procoagulant activity. Current treatments also do not propose an optimal time for anticoagulation. The efficacy of anticoagulant treatments depends on the time of therapy initiation. The best time for antithrombotic therapy is as early as possible after diagnosis, ideally in the early stage of the disease. We also elaborate on the possible mechanisms of long COVID thromboembolic complications, including persistent inflammation, endothelial injury and dysfunction, and coagulation abnormalities. The above-mentioned contents provide therapeutic strategies for COVID-19 patients and further improve patient outcomes.

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Antithrombotic treatment for valve prostheses: Which drug, which dose, and when?

Cited by 4 publications

References 81 publications

Aortic patient-prosthesis mismatch - does it matter? A review for cardiologists and cardiac surgeons

Aortic patient-prosthesis mismatch - does it matter? A review for cardiologists and cardiac surgeons

Safety and efficacy of direct oral anticoagulants in bioprosthetic valves: A systematic review and meta-analysis

Pathophysiological mechanisms of thrombosis in acute and long COVID-19

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