Thromboembolism and bleeding after mitral valve replacement with porcine valves: influence of thromboembolic risk factors.
The risk of postoperative thromboembolism (PTE), anticoagulant related hemorrhage (ARH), and the influence of thromboembolic risk factors ( TERF ) were assessed retrospectively in 206 unselected patients undergoing mitral valve replacement (MVR) with porcine xenobioprotheses ( PXBP ). Other aims were to identify the "high-risk" group with respect to PTE and to assess the effectiveness of long-term anticoagulant therapy (AT) in this subset, as well as to elucidate the most adequate method of AT and ascertain if AT is strictly necessary in patients undergoing MVR with PXBP . Patients were divided in two groups: Group I (N = 115) received long-term AT; there were 22 PTE. Group II (N = 91) with only 8 weeks of AT had 2 PTE (P less than 0.01). ARH was the same in both groups. Actuarially , 71.7% of the patients in group I and 96.3% of the patients in group II were free of PTE at 6 years. Long-term AT proved ineffective in preventing PTE and carried a significant incidence of ARH. ARH surpassed PTE (3.5:1) in patients on short-term AT. Patients without TERF have a low incidence of PTE, and AT is not indicated. The "high-risk" group were patients in postoperative atrial fibrillation and left atrial enlargement. One week heparin therapy and 3 months oral AT is suggested for patients with TERF . PXBP for MVR in patients with TERF is significantly thrombogenic. Early operation is advocated to avoid development of TERF that will affect patient outlook after MVR with PXBP due to the significantly increased risks of PTE and (if placed on AT) ARH.
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001705:Bioprosthesis / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*
D000925:Anticoagulants