title: Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair.
abstract: OBJECTIVE
  To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome.
  
  
  METHODS
  Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 ± 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286).
  
  
  RESULTS
  No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P = .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P = .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P = .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months.
  
  
  CONCLUSIONS
  Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.
authors.affiliation: U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy. Electronic address: domenico.paparella@uniba.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.affiliation: U.O. Cardiologia Università dell'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Department of Cardiac Surgery, Rambam Medical Centre, Haifa, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Bitton Worms
authors.affiliation: Department of Cardiac Surgery, Rambam Medical Centre, Haifa, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Bolotin
authors.affiliation: U.O. Cardiochirurgia Ospedale Niguarda Milano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.affiliation: U.O. Cardiochirurgia Ospedale Niguarda Milano, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Trunfio
authors.affiliation: U.O. di Chirurgia Cardiovascolare, Ospedale Polo Universitario Luigi Sacco, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scrofani
authors.affiliation: U.O. di Chirurgia Cardiovascolare, Ospedale Polo Universitario Luigi Sacco, Milano, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
authors.affiliation: U.O. Cardiochirurgia, Ospedale Mauriziano, Torino, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Actis Dato
authors.affiliation: U.O. Cardiochirurgia, Ospedale Mauriziano, Torino, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
authors.affiliation: U.O. di Cardiochirurga, Dipartimento di Scienze Cardio-toraco-vascolare, Università di Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.affiliation: U.O. di Cardiochirurga, Dipartimento di Scienze Cardio-toraco-vascolare, Università di Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Divisione di Cardiochirurgia, Università della Magna Grecia, Catanzaro, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.affiliation: Divisione di Cardiochirurgia, Università della Magna Grecia, Catanzaro, Italy.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Serraino
authors.affiliation: U.O. Cardiochirurgia, Ospedale Vito Fazzi, Lecce, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scrascia
authors.affiliation: U.O. Cardiochirurgia, Ospedale Vito Fazzi, Lecce, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Zaccaria
authors.affiliation: U.O. Cardiochirurgia, Ospedale San Raffele, Milano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: U.O. Cardiochirurgia, Ospedale San Raffele, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Ospedale Universitario Germans Trias Y Pujol, Badalona, Spagna.
authors.forename: Luis
authors.initials: L
authors.lastname: Delgado
authors.affiliation: U.O. Cardiochirurgia, Ospedale S. Anna E S. Sebastiano, Caserta, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tritto
authors.affiliation: U.O. Cardiochirurgia, Ospedale S. Anna E S. Sebastiano, Caserta, Italy.
authors.forename: Joseph
authors.initials: J
authors.lastname: Marmo
authors.affiliation: Divisione di Cardiochirurgia, IRCCS San Donato, San Donato Milanese, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.affiliation: Unità di Ricerca Clinica in Aterotrombosi, Centro Cardiologico Monzino, Milano, Italy.
authors.forename: Veronika
authors.initials: V
authors.lastname: Myaseodova
authors.affiliation: Divisione di cardiochirurgia, Ospedale Poliambulanza, Brescia, Italy.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villa
authors.affiliation: Divisione di cardiochirurgia, Ospedale Poliambulanza, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.affiliation: Unità di Cardiochirurgia, Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Unità di Cardiochirurgia, Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.affiliation: Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Whitlock
authors.affiliation: U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Conte
authors.affiliation: Division of Cardiac Surgery, Santa Croce hospital, Cuneo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: Experimental Surgery, Heart and Vessels Department, Careggi Hospital, Firenze, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: U.O. Cardiochirurgia, Spedali Civili, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: U.O. Cardiochirurgia, Spedali Civili, Brescia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.affiliation: U.O. di Cardiochirurgia, Università di Chieti, Chieti, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marinelli
authors.affiliation: U.O. di Cardiochirurgia, Università di Chieti, Chieti, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Giammarco
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Azmat
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Juan Jaime
authors.initials: JJ
authors.lastname: Alfonso
authors.affiliation: U.O. Cardiochirurgia, Ospedale Monasterio, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: U.O. Cardiochirurgia, Ospedale Monasterio, Massa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome; D014463:Ultrasonography; D014812:Vitamin K / Q000008:administration & dosage / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K
keywords: anticoagulation; antiplatelet; bleeding; mitral valve repair; stroke