OBJECTIVES: The aim of this study was to evaluate the risks and benefits of short-term anticoagulation in patients receiving aortic valve bioprostheses. BACKGROUND: Patients receiving aortic valve bioprostheses have an elevated early risk of thromboembolic events; however, the risks and benefits of short-term anticoagulation have been debated with limited evidence. METHODS: Our cohort consisted of 25,656 patients ≥65 years of age receiving aortic valve bioprostheses at 797 hospitals within the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2004 to 2006). The associated 3-month incidences of death or readmission for embolic (cerebrovascular accident, transient ischemic attack, and noncerebral arterial thromboembolism) or bleeding events were compared across discharge anticoagulation strategies with propensity methods. RESULTS: In this cohort (median age, 77 years), the 3 most common discharge anticoagulation strategies included: aspirin-only (49%), warfarin-only (12%), and warfarin plus aspirin (23%). Among those receiving aspirin-only, 3-month adverse events were low (death, 3.0%; embolic events, 1.0%; bleeding events, 1.0%). Relative to aspirin-only, those treated with warfarin plus aspirin had a lower adjusted risk of death (relative risk [RR]: 0.80, 95% confidence interval [CI]: 0.66 to 0.96) and embolic event (RR: 0.52, 95% CI: 0.35 to 0.76) but a higher risk of bleeding (RR: 2.80, 95% CI: 2.18 to 3.60). Relative to aspirin-only, warfarin-only patients had a similar risk of death (RR: 1.01, 95% CI: 0.80 to 1.27), embolic events (RR: 0.95, 95% CI: 0.61 to 1.47), and bleeding (RR: 1.23, 95% CI: 0.85 to 1.79). These results were generally consistent across patient subgroups. CONCLUSIONS: Death and embolic events were relatively rare in the first 3 months after bioprosthetic aortic valve replacement. Compared with aspirin-only, aspirin plus warfarin was associated with a reduced risk of death and embolic events, but at the cost of an increased bleeding risk.
OBJECTIVES: The aim of this study was to evaluate the risks and benefits of short-term anticoagulation in patients receiving aortic valve bioprostheses. BACKGROUND:Patients receiving aortic valve bioprostheses have an elevated early risk of thromboembolic events; however, the risks and benefits of short-term anticoagulation have been debated with limited evidence. METHODS: Our cohort consisted of 25,656 patients ≥65 years of age receiving aortic valve bioprostheses at 797 hospitals within the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2004 to 2006). The associated 3-month incidences of death or readmission for embolic (cerebrovascular accident, transient ischemic attack, and noncerebral arterial thromboembolism) or bleeding events were compared across discharge anticoagulation strategies with propensity methods. RESULTS: In this cohort (median age, 77 years), the 3 most common discharge anticoagulation strategies included: aspirin-only (49%), warfarin-only (12%), and warfarin plus aspirin (23%). Among those receiving aspirin-only, 3-month adverse events were low (death, 3.0%; embolic events, 1.0%; bleeding events, 1.0%). Relative to aspirin-only, those treated with warfarin plus aspirin had a lower adjusted risk of death (relative risk [RR]: 0.80, 95% confidence interval [CI]: 0.66 to 0.96) and embolic event (RR: 0.52, 95% CI: 0.35 to 0.76) but a higher risk of bleeding (RR: 2.80, 95% CI: 2.18 to 3.60). Relative to aspirin-only, warfarin-only patients had a similar risk of death (RR: 1.01, 95% CI: 0.80 to 1.27), embolic events (RR: 0.95, 95% CI: 0.61 to 1.47), and bleeding (RR: 1.23, 95% CI: 0.85 to 1.79). These results were generally consistent across patient subgroups. CONCLUSIONS:Death and embolic events were relatively rare in the first 3 months after bioprosthetic aortic valve replacement. Compared with aspirin-only, aspirin plus warfarin was associated with a reduced risk of death and embolic events, but at the cost of an increased bleeding risk.
Authors: Haris Riaz; Shehab Ahmad Redha Alansari; Muhammad Shahzeb Khan; Talha Riaz; Sajjad Raza; Faraz Khan Luni; Abdur Rahman Khan; Irbaz Bin Riaz; Richard A Krasuski Journal: Circ Cardiovasc Qual Outcomes Date: 2016-05-10
Authors: Jared P Beller; Elizabeth D Krebs; Robert B Hawkins; J Hunter Mehaffey; Mohammed A Quader; Alan M Speir; Andy C Kiser; Mark Joseph; Leora T Yarboro; Nicholas R Teman; Gorav Ailawadi Journal: J Thorac Cardiovasc Surg Date: 2019-09-28 Impact factor: 5.209
Authors: Anthony N DeMaria; Jeroen J Bax; Gregory K Feld; Barry H Greenberg; Jennifer L Hall; Mark A Hlatky; Wilbur Y W Lew; João A C Lima; Ehtisham Mahmud; Alan S Maisel; Sanjiv M Narayan; Steven E Nissen; David J Sahn; Sotirios Tsimikas Journal: J Am Coll Cardiol Date: 2013-01-22 Impact factor: 24.094
Authors: Daniel J Friedman; Jonathan P Piccini; Tongrong Wang; Jiayin Zheng; S Chris Malaisrie; David R Holmes; Rakesh M Suri; Michael J Mack; Vinay Badhwar; Jeffrey P Jacobs; Jeffrey G Gaca; Shein-Chung Chow; Eric D Peterson; J Matthew Brennan Journal: JAMA Date: 2018-01-23 Impact factor: 56.272
Authors: Dawn M Bravata; Jessica M Coffing; Devan Kansagara; Jennifer Myers; Lauren Murphy; Barbara J Homoya; Anthony J Perkins; Kathryn Snow; Jacquelyn A Quin; Ying Zhang; Laura J Myers Journal: JAMA Surg Date: 2019-02-20 Impact factor: 14.766
Authors: Renato D Lopes; Richard C Becker; L Kristin Newby; Eric D Peterson; Elaine M Hylek; Robert Giugliano; Christopher B Granger; Kenneth W Mahaffey; Antonio C Carvalho; Otavio Berwanger; Roberto R Giraldez; Gilson Soares Feitosa-Filho; Marcia M Barbosa; Maria da Consolacao V Moreira; Renato A K Kalil; Marildes Freitas; Joao Carlos de Campos Guerra; Marcio Vinicius Lins Barros; Thiago da Rocha Rodrigues; Antonio C Lopes; David A Garcia Journal: J Thromb Thrombolysis Date: 2013-07 Impact factor: 2.300