Is long-term warfarin therapy necessary in Chinese patients with atrial fibrillation after bioprosthetic mitral valve replacement and left atrial appendage obliteration?

Abstract

Long-term warfarin therapy has been used to decrease thromboembolic events in patients with atrial fibrillation (AF) following bioprosthetic mitral valve replacement (BMVR) and left atrial appendage obliteration (LAAO). A retrospective study was conducted to investigate the efficacy of long-term warfarin or aspirin therapy in patients with AF after BMVR and LAAO. A total of 215 patients with persistent AF were given anticoagulation therapy with warfarin for the first 3 months after BMVR and LAAO, continuing warfarin or aspirin therapy according to the surgeon's preference. A yearly follow-up with patients was performed by telephone or mail for postoperative condition, cerebrovascular, and bleeding events. Seven patients died in the first 3 months after surgery, including 6 patients from heart failure and 1 patient from sudden death. The remaining 208 patients were divided into two groups: warfarin group (n = 84 patients) and aspirin group (n = 124). The patients in the warfarin group were older than those in the aspirin group and had a lower postoperative left ventricular ejection fraction. Other baseline and operative characteristics were similar. The two groups had similar incidence of thromboembolic events (9.5% versus 8.9%, P = .873) and bleeding events（7.1% versus 3.2%, P = .207). Each group had one intracranial hemorrhage. Eleven patients expired within three months after surgery, 4（4.8%) in the warfarin group and 10（8.1%）in the aspirin group (P = .411 by Fisher exact test). Cumulative survival was not significantly different in the two groups by Kaplan-Meier analysis (P = .55, log-rank test). At the current time in China, long-term warfarin or aspirin therapy may have no significantly different impact on long-term prognosis after 3 months anticoagulation with warfarin in patients with AF undergoing BMVR and LAAO.