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Comparison of anticoagulation regimens after Carpentier-Edwards aortic or mitral valve replacement
K L Blair1, A C Hatton, W D White
1Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Insights
Aspirin alone is recommended for patients after Carpentier-Edwards aortic valve replacement, offering a low risk of bleeding and thromboembolism. For mitral valve replacement, anticoagulation strategies should be individualized based on patient factors.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Carpentier-Edwards valves are commonly used mechanical heart valves.
- Optimal anticoagulant therapy post-valve replacement is crucial for patient outcomes.
- Previous studies have yielded mixed results regarding anticoagulant efficacy and safety.
Purpose of the Study:
- To determine the optimal anticoagulant strategy following Carpentier-Edwards aortic and mitral valve replacement.
- To compare the rates of hemorrhage and thromboembolism among different anticoagulant regimens.
Main Methods:
- Retrospective analysis of patients who underwent Carpentier-Edwards aortic (N=378) or mitral (N=370) valve replacement.
- Patients were categorized by discharge anticoagulant therapy: warfarin, aspirin alone, or no therapy.
- Linearized rates of hemorrhage and thromboembolism were calculated and compared.
Main Results:
- Warfarin use was associated with a significantly higher rate of hemorrhage within 90 days compared to aspirin or no therapy (P = .03).
- After aortic valve replacement, aspirin alone showed a low thromboembolism rate, comparable to warfarin or no treatment (P = .07).
- For mitral valve replacement, warfarin's hemorrhage rate was similar to the thromboembolism rates observed with aspirin or no therapy.
Conclusions:
- Routine aspirin use appears safe and effective after Carpentier-Edwards aortic valve replacement, for both short-term and long-term management.
- Individualized anticoagulation strategies are recommended for patients after Carpentier-Edwards mitral valve replacement due to varying risks.
- These findings, from a retrospective study, provide evidence-based guidance for anticoagulant selection in mechanical heart valve recipients.
Background:
To identify the optimal use of anticoagulants after Carpentier-Edwards valve replacement, a retrospective study of all patients undergoing Carpentier-Edwards aortic (N = 378) or mitral (N = 370) valve replacement was done.
Methods And Results:
At the time of hospital discharge, 103 patients were managed with warfarin, 509 with aspirin alone, and 136 with no anticoagulation or antiplatelet therapy. Over the first 90 days after aortic or mitral valve replacement, the linearized rate of hemorrhage was greater for warfarin than for aspirin or no therapy (16.7 +/- 7.6%, 3.4 +/- 1.7%, and 3.1 +/- 3.1% per patient-year, respectively; P = .03). After aortic valve replacement, aspirin provided a low rate of thromboembolism (0.8 +/- 0.2% per patient-year), not significantly different from warfarin or no treatment (2.9 +/- 1.6% and 1.5 +/- 0.6% per patient-year) (P = .07). After mitral valve replacement, no single treatment was most advantageous because the rate of hemorrhage over the first 90 days for warfarin was equivalent to the 90-day rate of thromboembolism with aspirin or no therapy.
Conclusions:
Anticoagulation after Carpentier-Edwards mitral valve replacement may be best guided by individual patient characteristics. Within the limits of a retrospective analysis, these data support the routine use of aspirin alone after Carpentier-Edwards aortic valve replacement, both in the first 90 days and long-term.