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

Abstract

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 ...

The Biological Heart Valve in Aortic Position and its Effect on the Brain

“…TE events patients undergoing valve replacement for rheumatic heart disease are only observed within the first month, but not in the second and third month. Moreover, these patients are much younger [28]. The type of BHV does not seem to play a role: comparison of Carpentier-Edwards pericardial and Mosaic reveals no differences after 6 year follow-up [29].…”

Current Situation of Acute Rheumatic Fever and Rheumatic Heart Disease in Latin America and the Caribbean: A Systematic Review

“…Our search yielded a total of 2431 records of which 1692 were screened by title/abstract after duplicates were removed. One hundred seventy-nine records were sought for retrieval and ultimately 48 studies fulfilled the eligibility criteria [ 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ]. A PRISMA [ 11 ] flow diagram of our search strategy and reasons for the exclusion of full-text articles can be seen in Figure 1 .…”

“…Among those reporting operative mortality, proportions ranged from 0 to 13% [ 22 55 56 62 ], whereas in those reporting in-hospital or <30 days mortality, it ranged from 0% to 19.2% [ 24 29 35 40 52 53 56 ]. Some authors reported distinct follow-up periods for longer-term mortality (from 2 months up to 8 years of follow-up) [ 24 25 28 35 55 56 ] whereas others reported overall mortality during their total study period ranging from 0.6% to 20% [ 41 62 65 ]. Moreover, Ribeiro et al reported the mean annual incidence of in-hospital mortality (0.25 per 100,000) and of open-heart surgery for RHD (2.86 per 100,000) in Salvador, Brazil [ 53 ] ( Table 3 and Supplementary Table S9).…”

Antithrombotic Strategy in the Three First Months following Bioprosthetic Heart Valve Implantation

“…In the same year, Orszulak et al 10 showed an incidence of 40% in the first 30 days postoperatively. Finally, more recently, in 2013, in an article still in press, Duraes et al 11 prospectively analyzed a cohort of rheumatic patients in the first three postoperative months after mitral and/or aortic bioprosthetic implantation, showing a rare incidence of embolic events, regardless of being the aortic or mitral bioprosthesis, being even more sporadic in the latter, even when aspirin is compared with no antiplatelet agent, as shown in Tables 2 , 3 and 4 .…”