Author + information
- Claire Bouleti,
- Alain Leguerrier,
- Jean–Francois Obadia,
- Frederic Collart,
- Emanuelle Florens,
- Michel Marchand,
- Laurent Lepage,
- Genevieve Mulak and
- Bernard Iung
Antithrombotic therapy after bioprosthetic aortic valve replacement (AVR) is a debated issue. AVR is frequent given the high prevalence of aortic stenosis. The absence of consensus highlights the need for an evaluation of clinical practices.
Antithrombotic therapy after bioprosthetic AVR was prospectively studied in 434 patients between January and April 2011 in 14 centres. Patients previously treated with vitamin K antagonists (VKA) were excluded. Mean age was 75±9 years, 58% were male and 33% had coronary artery disease. Surgery was performed for aortic stenosis in 87% of cases and was combined with coronary artery bypass grafting (CABG) in 23% of cases.
In–hospital antithrombotic treatment was : aspirin alone in 65% of cases; VKA alone in 9%; VKA+ aspirin in 19%; and neither VKA nor aspirin in 7%. Factors that impacted the prescription of VKA were: coronary disease (p<0.001), associated CABG (p<0.007) and post–operative supraventricular arrhythmias (p<0.007). The strongest factor was the centre effect (p<0.0001) (Figure 1). There was no relationship between the prescription of VKA and in–hospital thromboembolic complications (p<0.21) or bleeding (p<0.31).
This multicentre prospective study shows that VKA are prescribed in only 28% of patients after bioprosthetic AVR, despite recommendations in Europe. VKA prescription seems to be mainly related to the centre effect. Homogenization of clinical practices is therefore needed.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Valvular Heart Disease: Clinical VI – Prosthetic Valve
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1241–84
- 2013 American College of Cardiology Foundation