title: Is long-term warfarin therapy necessary in Chinese patients with atrial fibrillation after bioprosthetic mitral valve replacement and left atrial appendage obliteration?
abstract: BACKGROUND
  Long-term warfarin therapy has been used to decrease thromboembolic events in patients with atrial fibrillation (AF) following bioprosthetic mitral valve replacement (BMVR) and left atrial appendage obliteration (LAAO). A retrospective study was conducted to investigate the efficacy of long-term warfarin or aspirin therapy in patients with AF after BMVR and LAAO.
  
  
  METHODS
  A total of 215 patients with persistent AF were given anticoagulation therapy with warfarin for the first 3 months after BMVR and LAAO, continuing warfarin or aspirin therapy according to the surgeon's preference. A yearly follow-up with patients was performed by telephone or mail for postoperative condition, cerebrovascular, and bleeding events.
  
  
  RESULTS
  Seven patients died in the first 3 months after surgery, including 6 patients from heart failure and 1 patient from sudden death. The remaining 208 patients were divided into two groups: warfarin group (n = 84 patients) and aspirin group (n = 124). The patients in the warfarin group were older than those in the aspirin group and had a lower postoperative left ventricular ejection fraction. Other baseline and operative characteristics were similar. The two groups had similar incidence of thromboembolic events (9.5% versus 8.9%, P = .873) and bleeding events（7.1% versus 3.2%, P = .207). Each group had one intracranial hemorrhage. Eleven patients expired within three months after surgery, 4（4.8%) in the warfarin group and 10（8.1%）in the aspirin group (P = .411 by Fisher exact test). Cumulative survival was not significantly different in the two groups by Kaplan-Meier analysis (P = .55, log-rank test).
  
  
  CONCLUSIONS
  At the current time in China, long-term warfarin or aspirin therapy may have no significantly different impact on long-term prognosis after 3 months anticoagulation with warfarin in patients with AF undergoing BMVR and LAAO.
authors.affiliation: Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China. Email:gaochq301@gmail.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China. Email:gaochq301@gmail.com.
authors.forename: Shengli
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China. Email:gaochq301@gmail.com.
authors.forename: Chonglei
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China. Email:gaochq301@gmail.com.
authors.forename: Changqing
authors.initials: C
authors.lastname: Gao
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000628:therapy; D001705:Bioprosthesis / Q000706:statistics & numerical data; D015984:Causality; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000401:mortality / Q000706:statistics & numerical data; D014600:Utilization Review; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin