warfarin and Bicuspid-Aortic-Valve-Disease

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Aortic Valve; Aortic Valve Stenosis; Benzoates; Bicuspid Aortic Valve Disease; Bioprosthesis; Chest Pain; Craniotomy; Echocardiography; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Enoxaparin; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hematoma, Subdural, Acute; Humans; Hydrazines; Immunologic Factors; Plasma Exchange; Purpura, Thrombocytopenic, Idiopathic; Pyrazoles; Recurrence; Rituximab; Stroke Volume; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Aortic Diseases; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Humans; Male; Sinus of Valsalva; Thrombosis; Transcatheter Aortic Valve Replacement; Treatment Outcome; Warfarin

Controversy persists regarding the advisability of anticoagulation for the early period after biological surgical aortic valve replacement (AVR). We aim to examine the impact of various antithrombotic regimens on outcomes in a large cohort of biological AVR patients. Records of 1,111 consecutive adult patients who underwent surgical biological AVR at our institution between 2013 and 2017 were reviewed. Outcomes included stroke, bleeding, and death at 3 and 12 months. Treatment regimens included (1) no therapy, (2) anticoagulants (warfarin or Factor Xa inhibitors), (2) antiplateles (various), and (4) anticoagulants + antiplatelets. Kaplan-Meier analysis was used to track outcomes, and Cox-proportional hazards regression models were conducted to analyze effects of different therapies on adverse events. At 3 months, thromboembolic events were low and not significantly different between the no therapy group (2.2%) and anticoagulation (2.8%) or anticoagulation + antiplatelet (3.6%) or all groups (3.7%). The antiplatelet group was just significantly lower, at 2.2%. However, this was driven by non-stroke cardiovascular events in patients with coronary artery disease. The incidence of death at 3 months was low and not significantly different between all groups. At 12 months, there were no thromboembolic benefits between groups, but bleeding events were significantly higher in the anticoagulation group (no therapy (1.4%), anticoagulation (8.4%), antiplatelet (4.5%), anticoagulation + antiplatelet (7.9%)). In conclusion, none of the antithrombotic regimens showed benefits in stroke or survival at 3 or 12 months after biological AVR. Anticoagulation increased bleeding events. Routine anticoagulation after biological AVR appears to be unnecessary and potentially harmful.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Aspirin; Atrial Fibrillation; Bicuspid Aortic Valve Disease; Bioprosthesis; Coronary Artery Disease; Factor Xa Inhibitors; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Platelet Aggregation Inhibitors; Postoperative Care; Proportional Hazards Models; Purinergic P2Y Receptor Antagonists; Stroke; Thromboembolism; Warfarin; Young Adult

Topics: Adult; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Bioprosthesis; Drug Resistance; Echocardiography, Doppler; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Mutation; Polymerase Chain Reaction; Polymorphism, Genetic; Postoperative Care; Retreatment; Rivaroxaban; Severity of Illness Index; Treatment Outcome; Vitamin K Epoxide Reductases; Warfarin

The need for anticoagulation after surgical aortic valve replacement (AVR) with biological prostheses is not well examined.. To perform a nationwide study of the association of warfarin treatment with the risk of thromboembolic complications, bleeding incidents, and cardiovascular deaths after bioprosthetic AVR surgery.. Through a search in the Danish National Patient Registry, 4075 patients were identified who had bioprosthetic AVR surgery performed between January 1, 1997, and December 31, 2009. Concomitant comorbidity and medication were retrieved. Poisson regression models were used to determine risk.. Incidence rate ratios (IRRs) of strokes, thromboembolic events, cardiovascular deaths, and bleeding incidents by discontinuing warfarin as opposed to continued treatment 30 to 89 days, 90 to 179 days, 180 to 364 days, 365 to 729 days, and at least 730 days after surgery.. The median duration of follow-up was 6.57 person-years. Estimated rates of events per 100 person-years in patients not treated with warfarin compared with those treated with warfarin with comparative absolute risk were 7.00 (95% CI, 4.07-12.06) vs 2.69 (95% CI, 1.49-4.87; adjusted IRR, 2.46; 95% CI, 1.09-5.55) for strokes; 13.07 (95% CI, 8.76-19.50) vs 3.97 (95% CI, 2.43-6.48; adjusted IRR, 2.93; 95% CI, 1.54-5.55) for thromboembolic events; 11.86 (95% CI, 7.81-18.01) vs 5.37 (95% CI, 3.54-8.16; adjusted IRR, 2.32; 95% CI, 1.28-4.22) for bleeding incidents; and 31.74 (95% CI, 24.69-40.79) vs 3.83 (95% CI, 2.35-6.25; adjusted IRR, 7.61; 95% CI, 4.37-13.26) for cardiovascular deaths within 30 to 89 days after surgery; and 6.50 (95% CI, 4.67-9.06) vs 2.08 (95% CI, 0.99-4.36; adjusted IRR, 3.51; 95% CI, 1.54-8.03) for cardiovascular deaths within 90 to 179 days after surgery.. Discontinuation of warfarin treatment within 6 months after bioprosthetic AVR surgery was associated with increased cardiovascular death.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aortic Valve; Bicuspid Aortic Valve Disease; Cardiovascular Diseases; Denmark; Drug Administration Schedule; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Incidence; Male; Middle Aged; Registries; Risk; Stroke; Thromboembolism; Warfarin

Topics: Anticoagulants; Aortic Valve; Bicuspid Aortic Valve Disease; Cardiovascular Diseases; Female; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Male; Thromboembolism; Warfarin