Aortic Bioprosthesis Without Early Anticoagulation-Risk of Thromboembolism

Babin‐Ebell, Jörg; Schmidt, Walter; Eigel, P; Elert, O.

doi:10.1055/s-2007-1013212

Cited by 28 publications

(17 citation statements)

References 1 publication

(1 reference statement)

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“…Among patients with bioprosthetic valves in the aortic position, who received subcutaneous heparin 22,500 IU/d and aspirin 100 mg/d for the first 14 to 22 days after operation, but did not receive oral anticoagulants, the frequency of thromboemboli during the first 6 months was 1 occurrence out of 57 subjects (1.8%). 40 Among patients who received oral anticoagulants and heparin 5,000 U subcutaneously every 12 h, 0 of 109 patients with prosthetic valves in the aortic position had thromboemboli during the first 3 months. 38 However, some showed no advantage of early anticoagulation among patients with bioprosthetic valves in the aortic position.…”

Section: First 3 Months After Insertion In the Aortic Positionmentioning

confidence: 99%

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Stein¹,

Alpert²,

Bussey³

et al. 2001

Chest

308

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Section: First 3 Months After Insertion In the Aortic Positionmentioning

confidence: 99%

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Stein¹,

Alpert²,

Bussey³

et al. 2001

Chest

308

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“…Moinuddeen et al [12] and Babin-Ebell et al [13] showed similar results when assessing patients retrospectively. Brueck et al [14] comparing ASA with no therapy in 288 consecutive patients with sinus rhythm did not find differences in the outcomes of functional status, embolic events and survival with 3 months of aortic bioprosthesis replacement.…”

Section: Discussionmentioning

confidence: 59%

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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“…5,6 To date, no randomized trials and few retrospective studies have compared the effectiveness of different regimens in preventing postoperative thromboembolism and hemorrhage after BAVR. Babin-Ebell et al 11 and Joyce and Nelson 30 found no benefit in early warfarin therapy compared with ASA and concluded that standard anticoagulation did not seem to be beneficial. Authors of 4 retrospective studies 9,[31][32][33] suggested the use of ASA therapy alone without short-term anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Comparing Warfarin With Aspirin After Biological Aortic Valve Replacement

et al. 2004

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Background— Patients with prosthetic heart valves have a higher risk of developing valve thrombosis and arterial thromboembolism. Antithrombotic therapy in the early postoperative period after biological aortic valve replacement (BAVR) is controversial. The American College of Cardiology/American Heart Association and European Society of Cardiology guidelines recommend the use of warfarin for the first 3 months after BAVR, although the American College Chest Physician guidelines suggest that the recommendations are very weak and that the risk/benefit is unclear. This prospective study investigated the efficacy of postoperative warfarin compared with aspirin in patients after aortic valve replacement. Methods and Results— Patients undergoing BAVR between 2001 and 2002 received 2 antithrombotic therapies: 141 patients received warfarin for the first 3 months, and 108 patients received only aspirin. The major end points evaluated were the rate of cerebral ischemic events, bleeding, and survival. There were 3 and 5 postoperative cerebral ischemic events between 24 hours and 3 months for patients treated with aspirin and warfarin, respectively. After 3 months, the incidence of cerebral ischemic events did not differ between the 2 groups. The rate of major bleeding events, the stroke-free survival, and the overall survival rates were not statistically significant between the warfarin and aspirin groups. Conclusions— There seem to be no advantages in performing early anticoagulation therapy compared with a low-antiplatelet regimen with regard to early cerebral ischemic events, bleeding, and survival. Currently there is no evidence to support the fact that warfarin is more effective than aspirin.

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Aortic Bioprosthesis Without Early Anticoagulation-Risk of Thromboembolism

Cited by 28 publications

References 1 publication

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

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

Comparing Warfarin With Aspirin After Biological Aortic Valve Replacement

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