title: Adherence to American College of Cardiology/American Heart Association guidelines for the management of anticoagulation in patients with mechanical valves undergoing elective outpatient procedures.
abstract: This study sought to establish the practice patterns of a diverse group of academic physicians, in the management of periprocedural anticoagulation for patients with mechanical heart valves, to study adherence to American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Physicians (n = 140) were surveyed to assess strategies for the periprocedural anticoagulation of patients with bileaflet mechanical heart valves undergoing 2 common outpatient procedures. Six patient scenarios with graded risk profiles were presented for each valve location (mitral and aortic). In >90% of high-risk patient scenarios, for which the ACC/AHA guidelines recommend periprocedural anticoagulation, anticoagulation was recommended, with minimal differences between physician specialties. However, periprocedural anticoagulation was also recommended in >70% of non-high-risk scenarios, for which the ACC/AHA guidelines recommend no periprocedural anticoagulation. Noncardiologists recommended anticoagulation more often in non-high-risk patients (p <0.01), especially for patients with aortic valve prostheses. Thus, academic physicians appropriately recommend periprocedural anticoagulation for high-risk patients with mechanical heart valves who undergo elective procedures. However, these data specifically suggest variability in practice for non-high-risk patients that are discordant with current ACC/AHA guidelines, with differences by treating specialty especially notable in this risk subset.
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. akirtane@bidmc.harvard.edu
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Aref M
authors.initials: AM
authors.lastname: Rahman
authors.forename: Pedro
authors.initials: P
authors.lastname: Martinezclark
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000592:standards*; D000925:Anticoagulants / Q000627:therapeutic use*; D001021:Aortic Valve; D001706:Biopsy; D002309:Cardiology / Q000592:standards; D003106:Colon / Q000601:surgery; D003113:Colonoscopy; D017558:Elective Surgical Procedures / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008943:Mitral Valve; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011292:Premedication / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000517:prevention & control; D014081:Tooth Extraction
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin