Anticoagulation therapy after bioprosthetic aortic valve replacement in Dutch cardiothoracic centres: acceptance of guidelines does not lead to overall implementation†
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Published on: May 21, 2017
Margreet W A Bekker1, Luc Noyez2, Henry A van Swieten2
1Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands margreet.bekker@radboudumc.nl.
Insights
Dutch cardiothoracic centers show low adherence to European guidelines for anticoagulation after biological aortic valve replacement. Significant variability in management persists despite guideline adoption.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pharmacology
Background:
- European guidelines for antiplatelet and anticoagulation management in cardiac surgery were adopted by the Netherlands Association of Cardiothoracic Surgery in 2012.
- Postoperative anticoagulation management after biological aortic valve replacement (BAVR) is critical for patient outcomes.
Purpose of the Study:
- To assess the awareness and implementation of European guidelines for anticoagulation therapy after BAVR in Dutch cardiothoracic centers.
- To evaluate the variability in current anticoagulation practices among these centers.
Main Methods:
- A nationwide questionnaire survey was conducted in all 16 Dutch cardiothoracic centers.
- Data collection occurred one month before and eight months after the guideline adoption.
- The survey focused on knowledge of, and adherence to, the new guidelines regarding anticoagulation post-BAVR.
Main Results:
- All 16 centers participated in the survey.
- Fifteen centers reported awareness of the guidelines, but only two modified their anticoagulation therapy.
- Only 7 out of 16 centers ultimately followed the European guidelines, with significant variation in prescribed anticoagulation (aspirin to coumarin, varying doses/durations).
Conclusions:
- Despite formal acceptance, the implementation of European guidelines for anticoagulation after BAVR remains suboptimal in the Netherlands.
- Considerable heterogeneity in postoperative anticoagulation management persists, highlighting a gap between guideline adoption and clinical practice.
Abstract:
In 2012, the Netherlands Association of Cardiothoracic Surgery accepted the new guidelines of the European Association for Cardio-Thoracic Surgery on antiplatelet and anticoagulation management in cardiac surgery. The aim of our study was to evaluate knowledge and implementation of these guidelines in Dutch cardiothoracic centres 8 months later, specifically after biological aortic valve replacement. One month prior to and 8 months after acceptance of the new guidelines, a questionnaire was sent to all 16 Dutch cardiothoracic centres about their current anticoagulation management after biological aortic valve replacement, their knowledge and implementation of the guidelines. All centres returned the questionnaire. Fifteen centres declared knowledge of the guidelines of which two adjusted their anticoagulation therapy. Four declared they did not follow the guidelines. However, of the remaining 11 centres, only 7 followed the guidelines. Between the centres, current anticoagulation therapy varied from aspirin to coumarin with different dosages and durations. Despite acceptance of the guidelines, only 7 of 16 centres followed them, and there remains great variability in the postoperative anticoagulation management after biological aortic valve replacement in Netherlands.
