Low-dose acetyl salicylic acid versus oral anticoagulation after bioprosthetic aortic valve replacement. Final report of the ACTION registry

Colli, Andrea; Verhoye, Jean‐Philippe; Heijmen, Robin H.; Antunes, Manuel J.

doi:10.1016/j.ijcard.2012.11.056

Cited by 25 publications

(22 citation statements)

References 24 publications

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“…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]. Remarkably, compared to VKA, aspirin resulted in a lower TE event rate after AVR with concomitant CABG [30].…”

Section: Resultsmentioning

confidence: 94%

“…In younger patients, this was significantly better, being 97.5% [36]. In contrast, patients undergoing AVR with concomitant CABG, less TE events are recorded with aspirin, compared to VKA [30]. Another patient related factor, carotid artery stenosis, does not seem to relate to stroke after AVR/CABG [10,37,38].…”

Section: Resultsmentioning

confidence: 95%

“…Contradictorylong-term results between series could be the result of 1) their retrospective nature, 2)too few events which makes these series under powered, 3) variation in detecting TE events, 4) application of different antithrombotic regimen, especially with newer agents such as factor Xa inhibitors, 5) patient experience and compliance, 6) stability of INR, 7) metabolic variation, 8) pharmacological interaction, 9)the surgeon's discretion concerning VKA inhibitorsand 10) other patient-related factors [26,30,43]. It seems that large RCT are needed to make differences between the many possible regimens visible for events that have a low occurrence rate [42,26].…”

Section: Discussionmentioning

confidence: 99%

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

Mistiaen¹

2014

CSR

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Thromboembolic events are a major complication of valve replacement. Most of these occur in the brain, with devastating consequences. Biological heart valve prostheses have been designed to reduce these complications as much as possible. This has the advantage that they require less antithrombotic agents compared to mechanical valves. However, thromboembolic events still do occur. The main question is: are such devices thrombogenic on long-term? For this reason, only long-term results have been included. A literature review reveals that there are several sources of emboli: the diseased native valve itself as well as other cardiovascular conditions such as atrial fibrillation or poor left ventricular function. Annual rate of thromboembolism of different series have been compared as well as the effect of several antithrombotic regimens during the first three postoperative months, since this is the most hazardous period. The results of trans-catheter aortic valve implantation have also been added since this is a way to treat patients who cannot stand the trauma of valve surgery. High age and risk scores make comparison with valve surgery difficult however. In either case, the rate of thromboembolism is rather low. Anticoagulation is probably needed within the first three months. If additional risk factors are present, life-long anticoagulation becomes necessary. However, there are some serious limitations in this review. The most important are the lack of standardization of recording embolic events and the value of possible surrogate parameters such as brain lesions on magnetic resonance imaging and cognitive decline. Large scale randomized controlled trials to identify the best antithrombotic protocol are difficult to design: because of confounding patient-related risk factors, large patient number needed to detect significant differences, and large variations in possible combinations of agents. However, every effort should be made to register every event in an adequate and standardized way.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

Mistiaen¹

2014

CSR

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“…Follow-up for mortality and redo surgery varied among individual studies, as detailed in table 2. Only four studies reported the incidence of heart failure with reduced ejection fraction (<30%–35%) 9 13 15 17…”

Section: Resultsmentioning

confidence: 99%

Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis

Masri

Gillinov

Johnston

et al. 2016

Heart

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“…The ACTION registry collected data at 47 medical centers in Europe, Canada, and India. Despite not being randomized it is nevertheless a prospective investigation of the efficacy of aspirin versus warfarin in patients who underwent aortic valve replacement or combined with coronary artery bypass grafts (AVR or AVR ± CABG).…”

Section: Early Anticoagulation With Warfarin Vs Aspirinmentioning

confidence: 99%