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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Antithrombotic Medication and Major Complications After Mechanical Aortic Valve Replacement
Rikhard Björn1, Joonas Lehto1, Markus Malmberg1
1Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
The American Journal of Cardiology
|August 6, 2023
Summary
Patients undergoing mechanical aortic valve replacement (AVR) face a higher risk of major bleeding than stroke, despite vitamin K antagonist (VKA) therapy. Managing bleeding risks is crucial for improving outcomes after AVR.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Mechanical aortic valve replacement (AVR) necessitates lifelong anticoagulation with vitamin K antagonists (VKAs) to prevent thromboembolic events.
- While VKAs are effective for stroke prevention, they significantly increase the risk of bleeding complications.
Purpose of the Study:
- To evaluate the efficacy and safety of antithrombotic therapy after mechanical AVR.
- To assess the incidence, timing, and characteristics of stroke and bleeding events in patients with mechanical AVR.
Main Methods:
- A cohort study including 308 patients who underwent isolated mechanical AVR.
- Follow-up data were collected for 306 patients (99.4%) with a median follow-up of 7.3 years.
Main Results:
- Major bleeding occurred significantly more frequently than major stroke (event rates 3.1 vs 0.5 per 100 patient-years).
- At 30 days and long-term follow-up, the risk for major bleeding was 5-fold higher than for major stroke.
- Gastrointestinal bleeding was the most common site (41.7%) during long-term follow-up; intracranial hemorrhage occurred in 18.3% of bleeds.
Conclusions:
- Antithrombotic therapy after mechanical AVR demonstrates good efficacy in stroke prevention but inadequate safety due to high bleeding rates.
- Major bleeding is a frequent and clinically relevant complication, necessitating improved management of modifiable bleeding risk factors.
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