Comparing warfarin with aspirin after biological aortic valve replacement: A prospective study

Gherli, Tiziano; Colli, Agostino; Fragnito, C

doi:10.1016/j.accreview.2004.10.078

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…Advances in technology offer the heart surgeon new kinds of biological valve prostheses with no absolute indication for warfarin anticoagulation [36][37][38], so there are increasing numbers of patients who are only receiving antiplatelet therapy who might be at high risk of PE. Our findings, therefore, suggest that the proposal to reduce use of anticoagulants in prosthetic heart surgery patients is premature because surgical criteria alone are not capable of deciding on antiplatelet rather than anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 99%

Deep venous thrombosis of the neck and pulmonary embolism in patients with a central venous catheter admitted to cardiac rehabilitation after cardiac surgery: a prospective study of 815 patients

et al. 2008

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Central venous catheters (CVCs) are widely used for therapeutic purposes and to measure hemodynamic variables that cannot be recorded from a peripheral vein. However, the method can involve complications. In cardiac surgery, CVCs are electively placed in the right internal jugular vein but there is little information on deep venous thrombosis (DVT) in catheterized veins (CVC-related DVT) or on secondary pulmonary embolism (PE). The impact of CVC-related DVT and PE in cardiac surgery and measures to prevent PE were assessed. We used ultrasonography (US) to check the point of insertion of CVC in 815 patients in the intensive cardiac rehabilitation unit after heart surgery. In this series, 386 patients (48%) had CVC-related DVT; those already receiving anticoagulant, and considered at low risk, continued that therapy, while those taking an antiplatelet agent (aspirin 100 mg daily) but deemed at high risk of PE from the US findings were given an anticoagulant instead. Only patients with CVC-related DVT at low risk of PE continued taking aspirin. At 3 months, there were no cases of PE among patients receiving an anticoagulant, but six on antiplatelet had non-fatal PE. The prevalence of PE in the whole series of 815 patients was 0.7%. CVC-related DVT is a frequent complication of heart surgery. Anticoagulant therapy started early does not prevent thrombus formation but probably prevents PE, whereas antiplatelet gives no such protection. Sonographic screening of the CVC removal in intensive care unit may be useful for avoiding PE after CVC-related DVT.

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Section: Discussionmentioning

confidence: 99%

Deep venous thrombosis of the neck and pulmonary embolism in patients with a central venous catheter admitted to cardiac rehabilitation after cardiac surgery: a prospective study of 815 patients

et al. 2008

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“…Handelt es sich beim Klappenersatz um eine biologische Prothese, müs-sen die Betroffenen in den ersten 3 Monaten nach der Operation bis zur Endothelialisierung des implantierten Fremdmaterials oral antikoaguliert werden. Hierbei kann bei Klappenmaterial in Aortenposition alternativ für ebenfalls 3 Monate eine Thrombozytenaggregationshemmung erfolgen [60]. Nach Herzklappenrekonstruktionen ist ein analoges Vorgehen wie bei biologischem Klappenersatz zu wählen.…”

Section: Antikoagulationunclassified

Herzklappenerkrankungen

et al. 2011

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The probability of treating patients with valvular heart disease during non-cardiac surgery increases with the age of the patient. The prevalence of valvular heart disease is approximately 2.5% and increases further in the patient group aged over 75 years old. Patients with valvular heart disease undergoing non-cardiac surgery have an increased perioperative cardiovascular risk depending on the severity of the disease. Knowledge of the hemodynamic alterations and compensation mechanisms which accompany diseases of the valve apparatus is essential for a suitable treatment of patients with such pre-existing diseases. The most common valvular heart diseases lead to volume (mitral valve insufficiency) or pressure load (aortic stenosis) of the left ventricle and in the case of mitral stenosis to a pressure load on the left atrium. Depending on the underlying disease and the type of surgery planned a corresponding choice of anesthesia procedure and medication must be made. In the present review article the pathophysiology of the relevant valvular heart diseases and the implications for perioperative anesthesia management will be presented. An individually tailored extended perioperative monitoring allows hemodynamic alterations to be rapidly recognized and adequately treated.

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“…Despite the lack of randomized studies confirming its safety, low-dose (75-100 mg) aspirin is commonly used as an alternative to anticoagulation for the first 3 months in many centers [20].…”

Section: Oral Anticoagulationmentioning

confidence: 99%

Antithrombotic Therapy for Patients with Valvular Heart Disease

Vahanian

2008

Herz

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To avoid the devastating consequences of thromboembolism and bleeding in patients with valve disease, in particular those with prosthetic valves, it is of utmost importance to correctly manage anticoagulation.Patients with mitral stenosis and either permanent or paroxysmal atrial fibrillation should receive anticoagulation, whereas those in sinus rhythm should only receive it in selected cases. In patients with prosthetic valves, anticoagulation management should be governed by the risk-benefit ratio taking factors related both to the patient and the prosthesis into account. Aspirin should be added only when there is a specific indication, such as concomitant arterial disease or embolism. In the future, improvements will be the result of the development of less thrombogenic valve substitutes, increased performance of conservative procedures, development of new antithrombotic agents, and, finally, increased use of self-assessment by better-educated patients.

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Comparing warfarin with aspirin after biological aortic valve replacement: A prospective study

Cited by 10 publications

References 22 publications

Deep venous thrombosis of the neck and pulmonary embolism in patients with a central venous catheter admitted to cardiac rehabilitation after cardiac surgery: a prospective study of 815 patients

Deep venous thrombosis of the neck and pulmonary embolism in patients with a central venous catheter admitted to cardiac rehabilitation after cardiac surgery: a prospective study of 815 patients

Herzklappenerkrankungen

Antithrombotic Therapy for Patients with Valvular Heart Disease

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