Abstract
Objectives: Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for 3 months postoperatively. We examined the continuation of oral anticoagulation (OAC) treatment and its effect on the long-term prognosis after BAVR.Methods: We used nation-wide register data from 4,079 individuals who underwent BAVR. We examined the association between warfarin and the non-vitamin K antagonist oral anticoagulant use with death, stroke and major bleeding in 2010 – 2016.Results: The risk of stroke was higher (HR 2.39, 95% CI 1.62 – 3.53, p < 0.001) and the risk of death was lower (HR 0.79, 95% CI 0.65 – 0.96, p = 0.016) in OAC-users compared to individuals without OAC. We observed no significant associations between OAC use and bleeding risk.Conclusion: OAC use after BAVR was associated with increased risk of stroke and decreased risk of death. These observational findings warrant validation in randomized controlled trials before any clinical conclusions can be drawn.
Highlights
Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for the first 3 months after operation either with warfarin or low-dose aspirin (75–100 mg daily) [1,2,3]
Oral anticoagulation therapy (OAC) often continues in many patients after the first 3-month period due to atrial fibrillation (AF) or other conditions that increase the risk of thromboembolic complications
non-vitamin K antagonist oral anticoagulants (NOACs) may be used in patients with AF and valvular heart disease (VHD) excluding moderate-to-severe mitral stenosis and mechanical heart valves [2, 5, 6]
Summary
Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for the first 3 months after operation either with warfarin or low-dose aspirin (75–100 mg daily) [1,2,3]. Oral anticoagulation therapy (OAC) often continues in many patients after the first 3-month period due to atrial fibrillation (AF) or other conditions that increase the risk of thromboembolic complications. Warfarin is currently the only OAC with an indication for early thromboembolism prophylaxis after BAVR [2, 3]. Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used as they are known to prevent stroke or thromboembolisms at least as well as warfarin in AF patients [5, 6]. NOACs may be used in patients with AF and valvular heart disease (VHD) excluding moderate-to-severe mitral stenosis and mechanical heart valves [2, 5, 6]
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