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Antithrombotic therapy after cardiac valve surgery: prospective real-world data of Class II guidelines application

Bram Roosens1, Bernard Iung2, Julia Mascherbauer3

  • 1Centrum voor Hart- en Vaatziekten, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.

Research and Practice in Thrombosis and Haemostasis
|September 11, 2025
PubMed

Insights

Antithrombotic therapy (AT) adherence after cardiac valve surgery varies. Recommended AT may reduce mortality, but more research is needed to confirm benefits and optimize strategies.

Area of Science:

  • Cardiology
  • Clinical Research
  • Pharmacology

Background:

  • Antithrombotic therapy (AT) post-cardiac valve surgery presents complex clinical challenges.
  • Current guidelines for AT are often based on limited empirical evidence.
  • Real-world application of AT recommendations requires further investigation.

Purpose of the Study:

  • To assess adherence to European Society of Cardiology (ESC) guidelines for AT in valve surgery patients.
  • To evaluate the 6-month impact of guideline-recommended AT on patient outcomes.
  • To identify factors influencing AT decisions in clinical practice.

Main Methods:

  • Prospective, observational subanalysis of the EURObservational Research Programme Valvular Heart Disease II survey.
  • Inclusion of 6 substudies covering diverse valve interventions and AT regimens.
  • Comparison of patient demographics, clinical characteristics, and 6-month outcomes between recommended AT and non-AT groups.

Main Results:

  • Guideline adherence for AT demonstrated wide variability (39.5%-81.1%) across substudies.
  • Factors influencing AT decisions included cardiovascular risk, atrial fibrillation, and prior percutaneous coronary intervention.
  • Unadjusted analyses suggested higher 6-month all-cause mortality in patients not receiving recommended AT, with no significant differences in thromboembolic events or bleeding at 6 months.

Conclusions:

  • Guideline-recommended AT may offer potential mortality benefits in specific patient cohorts after valve surgery.
  • The observational design limits definitive causal inferences regarding AT efficacy.
  • Further prospective research is crucial for optimizing AT strategies and improving outcomes, especially with emerging therapies and valve technologies.
Abstract

Keywords:
anticoagulationantiplatelet therapycardiac valve surgeryregistryvalve disease

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