Should we anticoagulate after bioprosthetic aortic valve replacement?
There is a lack of consensus as to the ideal antithrombotic strategy after bioprosthetic aortic valve replacement. Herein, the authors review the literature on this topic and find that most of the evidence is comprised of small observational data, with a few prospective trials. The bulk of the evidence is in favor of no anticoagulation after bioprosthetic aortic valve replacement in patients at low risk of thromboembolism. Most studies suggest using only antiplatelet therapy with the exception of two studies that advocate anticoagulation. One study suggests that no antithrombotic therapy at all may be safe. One study evaluated the question mechanistically, showing no increased microembolic signals on transcranial Doppler in patients receiving aspirin compared to patients who were anticoagulated. Based on the evidence presented, the authors recommend using aspirin only after bioprosthetic aortic valve replacement in patients at low risk of thromboembolism.
Division of Cardiac Surgery, University of Ottawa, Heart Institute, 40 Ruskin Street, Suite 3402, Ottawa, Ontario, K1Y 4W7, Canada.
Talal
T
Al-Atassi
Hadi
H
Toeg
Marc
M
Ruel
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D017585:Ultrasonography, Doppler, Transcranial
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin