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Long-Term Outcomes of Anticoagulation for Bioprosthetic Valve Thrombosis

Ioana Petrescu1, Alexander C Egbe2, Filip Ionescu1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Beaumont Health System, Royal Oak, Michigan.

Journal of the American College of Cardiology
|March 5, 2020
PubMed

Insights

Anticoagulation effectively treats bioprosthetic valve thrombosis (BPVT), but long-term outcomes show increased bleeding and re-BPVT risk. Patients with BPVT experienced higher rates of valve re-replacement, necessitating careful consideration of indefinite anticoagulation.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Outcomes Research

Background:

  • Bioprosthetic valve thrombosis (BPVT) is a rare but serious complication after heart valve replacement.
  • While anticoagulation is effective for acute BPVT, long-term outcomes and risks remain incompletely understood.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of patients diagnosed with bioprosthetic valve thrombosis (BPVT).
  • To assess the efficacy and safety of anticoagulation therapy in managing BPVT and its sequelae.

Main Methods:

  • A matched cohort study comparing 83 patients with BPVT treated with warfarin to 166 control subjects.
  • Matching criteria included age, sex, implantation year, and prosthesis type/position.
  • Median follow-up was 34 months.

Main Results:

  • Echocardiographic normalization occurred in 75% of BPVT patients within 3 months; 25% did not respond to warfarin.
  • No significant difference in the primary composite endpoint between BPVT patients and controls.
  • BPVT patients had a higher rate of major bleeding (12% vs. 2%) and valve re-replacement (68% vs. 24% at 10 years).
  • Recurrent BPVT (re-BPVT) occurred in 23% of responders, with most responding to further anticoagulation.

Conclusions:

  • Bioprosthetic valve thrombosis is associated with recurrent thrombosis and early prosthetic degeneration.
  • Indefinite warfarin anticoagulation may be considered for confirmed BPVT, balancing efficacy against increased bleeding risk.
  • Long-term monitoring and management strategies are crucial for patients with BPVT.
Abstract

Keywords:
anticoagulationbioprosthetic valve thrombosisprosthetic valve failure

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