Risk of thromboembolism with the aortic Carpentier-Edwards bioprosthesis

A High-Risk Period for Cerebrovascular Events Exists After Transcatheter Aortic Valve Implantation

“…The American College of Cardiology/ American Heart Association guidelines recommend aspirin alone in patients without additional risk factors, but they state that warfarin for 3 months is reasonable (17). However, the European Society of Cardiology guidelines recommend 3 months of VKA (18). These differences have arisen as some studies suggest that VKA is effective, whereas others suggest benefit is limited to high-risk subsets (patients with low left ventricular ejection fraction or atrial fibrillation) (19).…”

Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue

“…In 1988, Turpie et al reported a low rate of serious bleeding complications with low-dose anticoagulation and a target INR kept between 2.0 and 2.3, [36], while in 1995, Orszulak et al found that the early use of warfarin after bioprosthetic AVR was beneficial only among patients with high-risk characteristics, including a depressed left ventricular function, older age, and preoperative atrial fibrillation or paced rhythm [12]. Nevertheless, in 1998, Tiede et al, in a review article, recommended anticoagulation with warfarin in all patients [49].…”

“…Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described [6][7][8][9][10][11][12][13][14][15][16], a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement (AVR) has not been developed. The 2006 guidelines issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) for valve replacement recommend the prescription of acetyl salicylic acid (ASA) to all recipients of bioprosthetic heart valves (Class I, Level of evidence C) as well as to consider anticoagulating with a vitamin K antagonist (VKA) for 3 months after bioprosthetic AVR, to reach an INR between 2.0 and 3.0, an acceptable alternative but certainly not a primary recommendation (Class IIa, Level of evidence C) [17].…”

Comparing Warfarin With Aspirin After Biological Aortic Valve Replacement

“…This high recommended level of anticoagulation therapy can explain the higher rate of bleeding in these patients compared with those previously reported. 25 21 showed that early use of warfarin was beneficial only on a specific subset of patients who received BAVR. Nevertheless, in 1998 a review by Tiede et al 37 recommended the use of warfarin therapy for all patients.…”

“…Many regimens have been described. These regimens have included no anticoagulation or antiplatelet therapy at any time, 21,22 ASA or warfarin for 6 weeks, 12 warfarin for 4 to 12 weeks followed by no therapy, 5,23,24 warfarin for 3 months followed by ASA for 1 to 2 years, 25 long-term use of ASA only, 26,27 subcutaneous heparin for 1 to 4 weeks followed by or associated with warfarin for 1 to 3 months, 28 and ticlopidine for the first 3 months. 29 The guidelines published by the AHA/ACC, ESC, and ACCP 1-3 clearly recommend the use of an anticoagulation regimen for the first 3 months after BAVR in patients with no thromboembolic risk factors.…”