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Published on: October 16, 2021
Risk of death and stroke associated with anticoagulation therapy after mitral valve repair
Nana Valeur1, Charlotte Mérie2, Morten Lock Hansen2
1Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
Insights
Vitamin K antagonist (VKA) therapy following mitral valve repair significantly reduces the risk of stroke or death within the first three months post-surgery. This benefit is observed without a corresponding increase in major bleeding complications.
Area of Science:
- Cardiovascular Surgery
- Clinical Cardiology
- Pharmacology
Background:
- Current guidelines recommend oral anticoagulation for three months post-mitral valve repair, based on limited evidence.
- Previous studies have yielded conflicting results regarding the benefits of anticoagulation after this procedure.
Purpose of the Study:
- To evaluate the association between vitamin K antagonist (VKA) use and the risk of stroke or death after mitral valve repair.
- To assess the safety of VKA therapy in terms of major bleeding complications.
Main Methods:
- Analysis of national registry data for Danish patients undergoing mitral valve repair between 1997 and 2012.
- Utilized Cox regression, landmark analyses, and propensity-matched models to assess the risk of stroke/death and bleeding.
- Included 2188 patients discharged without prior VKA use, stroke, or death within seven days.
Main Results:
- Patients discharged on VKAs (39%) showed a significantly lower risk of death/stroke at 3 months (HR=0.28) compared to those not on VKAs.
- The risk reduction for death/stroke between 3 and 6 months was not statistically significant (HR=0.85).
- Major bleeding complications within 3 months were comparable between VKA users (1%) and non-users (2%).
Conclusions:
- Vitamin K antagonist treatment after mitral valve repair is associated with a substantially reduced risk of adverse events like stroke or death within the initial three months.
- The study suggests that VKA therapy is safe in this period, with no excess major bleeding risk observed.
Objective:
Guidelines generally recommend oral anticoagulation to be considered the first 3 months after mitral valve repair based on small studies and consensus. However, in several studies no benefit of anticoagulation has been found.
Methods:
From the national registries we identified all Danish patients who underwent mitral valve repair during the period between 1997 and 2012. Medication, hospitalisation and mortality data were studied. The association of use of vitamin K antagonists (VKAs) at discharge and risk of stroke/death was evaluated by means of Cox regression, landmark analyses and propensity matched models.
Results:
2188 patients without prior VKA use, stroke or death day 7 after discharge were included and median follow-up was 4.9 years (0-13.7). 859 (39%) were discharged on VKAs and 523 (24%) experienced death or stroke, 60 of these occurred within the first 3 months and 24 between 3 and 6 months. Compared with patients without post-discharge VKA, patients on VKA had a lower risk of death/stroke at 3 months (HR=0.28, CI (0.13 to 0.62), p=0.002) and in the time period from 3 to 6 months (HR=0.85, CI (0.35 to 2.07), p=0.72). Risk of significant bleeding complications within 3 months were comparable in the two groups with 23 (2%) among patients without VKA and 6 (1%) among VKA-treated.
Conclusion:
VKA treatment after mitral valve repair is associated with a markedly lower risk of adverse events as stroke or death without excess major bleeding risk during the first 3 months following surgery.
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