An audit of anticoagulation practice among UK cardiothoracic consultant surgeons following valve replacement/repair.
OBJECTIVE
In 1998, the American College of Cardiology and The American Heart Association (ACC/AHA) published guidelines for the postoperative anticoagulation of patients who have undergone heart valve replacement. The American College of Chest Physicians made similar recommendations in 2001. The present survey was conducted to review anticoagulation practice among UK consultant cardiac surgeons, and to assess compliance with these guidelines.


METHODS
An anonymous postal questionnaire was distributed to 185 adult cardiac surgeons identified from the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS).


RESULTS
The analysis was based upon 97 replies. All consultants use lifelong warfarin after mechanical valve replacement. In general, target INR ranges were lower for aortic valves compared with mitral valves. Some 53% (51/97) of consultants never use warfarin after bioprosthetic aortic valve replacement (AVR), compared with 33% (28/86) after bioprosthetic mitral valve replacement (MVR). Temporary (< or = 3 months) warfarin is used by 47% (46/97) of consultants after bioprosthetic AVR and by 63% (54/86) after bioprosthetic MVR. Some 64% (52/81) of consultants use warfarin after mitral valve repair, when an annuloplasty ring is inserted. This was always temporary (< or = 6 months). Aspirin is used long term by 54% (44/82) of consultants after mitral valve repair.


CONCLUSIONS
All consultant cardiac surgeons adequately anticoagulate their patients after mechanical valve replacement. Only 16% (16/97) of cardiac surgeons follow current guidelines for the postoperative anticoagulation of bioprosthetic AVR. Only 28% (24/86) of consultant cardiac surgeons comply with guidelines for bioprosthetic MVR. No guidelines exist for the anticoagulation of patients after mitral valve repair. Guidelines need to be reviewed for the anticoagulation of patients undergoing bioprosthetic valve replacement and formulated for patients undergoing mitral valve repair.
Vaughan
Paul
P
Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK. paul_vaughan@hotmail.com
Waterworth
Paul D
PD
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use; D001705:Bioprosthesis / Q000592:standards; D003253:Consultants; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000592:standards; D006349:Heart Valve Diseases / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000592:standards; D006801:Humans; D019934:International Normalized Ratio; D007494:Ireland; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery; D016896:Treatment Outcome; D006113:United Kingdom; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin