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Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement?

Sundt, TM; Zehr, KJ; Dearani, JA; Daly, RC; Mullany, CJ; McGregor, CGA; Puga, FJ; ... Schaff, HV; + view all (2005) Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement? J Thorac Cardiovasc Surg , 129 (5) pp. 1024-1031. 10.1016/j.jtcvs.2004.11.028.

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Abstract

OBJECTIVES: Freedom from anticoagulation is the principal advantage of bioprosthesis; however, the American Heart Association/American College of Cardiology and the American College of Chest Physicians guidelines recommend early anticoagulation with heparin, followed by warfarin for 3 months after bioprosthetic aortic valve replacement. We examined neurologic events within 90 days of bioprosthetic aortic valve replacement at our institution. METHODS: Between 1993 and 2000, 1151 patients underwent bioprosthetic aortic valve replacement with (641) or without (510) associated coronary artery bypass. By surgeon preference, 624 had early postoperative anticoagulation (AC+) and 527 did not (AC-). In the AC- group, 410 patients (78%) received antiplatelet therapy. Groups were similar with respect to gender (female, 36% AC+ vs 40% AC-, P = .21), hypertension (64% AC+ vs 61%, P = .27), and prior stroke (7.6% AC+ vs 8.5% AC-, P = .54). The AC+ group was slightly younger than the AC- group (median, 76 years vs 78 years, P = .006). RESULTS: Operative mortality was 4.1% with 43 (3.7%) cerebrovascular events within 90 days. Excluding 18 deficits apparent upon emergence from anesthesia, we found that postoperative cerebrovascular accident occurred in 2.4% of AC+ and 1.9% AC- patients. By multivariable analysis, the only predictor of operative mortality was hypertension ( P < .0001). Postoperative cerebrovascular accident was unrelated to warfarin use ( P = .32). The incidence of mediastinal bleeding requiring reexploration was similar (5.0% vs 7.4%), as were other bleeding complications in the first 90 days (1.1% vs 0.8%). No variables were predictive of bleeding by multivariate analysis. CONCLUSIONS: Although these data do not address the role of antiplatelet agents, early anticoagulation with warfarin after bioprosthetic aortic valve replacement did not appear to protect against neurologic events.

Type: Article
Title: Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement?
Location: United States
DOI: 10.1016/j.jtcvs.2004.11.028
Keywords: Aged, Anticoagulants, Aortic Valve, Bioprosthesis, Coronary Artery Bypass, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Hemorrhage, Humans, Incidence, Length of Stay, Logistic Models, Male, Multivariate Analysis, Patient Selection, Postoperative Care, Proportional Hazards Models, Prosthesis Failure, Reoperation, Retrospective Studies, Risk Factors, Stroke, Time Factors, Treatment Outcome, Warfarin
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: http://discovery.ucl.ac.uk/id/eprint/1373685
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