Antithrombotic therapy in patients after valve surgery with special attention to the combination of anticoagulant and antiplatelet therapy

Abstract

Patients after implantation of mechanical valves need life-long anticoagulant therapy. Nearly 30% of these patients have also indication for antiplatelet therapy because of concomitant ischemic heart disease or peripheral arterial disease. Combined anticoagulant and dual antiplatelet therapy (so called triple therapy - aspirin, clopidogrel and vitamin K antagonists) is indicated in patients with acute coronary syndrome and after percutaneous coronary intervention (PCI) for a different time according to the type of stent used during the procedure. Triple therapy is substantially more efficacious in reducing the occurrence of cardiovascular events and mortality in patients undergoing PCI with an indication for long-term anticoagulant therapy, compared with dual antiplatelet therapy. On the other hand it carries 3.5 to 4 times higher risk of bleeding in treated patients. Recently new anticoagulants (dabigatran, rivaroxaban, apixaban) and antiplatelet drugs (prasugrel and ticagrelor) came into clinical practice and new studies using these drugs are underway.The purpose of this review article is to summarize current approach to patients with indication for anticoagulant and antiplatelet therapy after valve surgery.