title: Anticoagulation After Biological Aortic Valve Replacement: Is There An Optimal Regimen?
abstract: The anticoagulation of biological heart valves remains a 'hot spot' of discussion in various domains due to the risk of developing valve thrombosis and arterial thromboembolism. The situation has always been controversial, especially during the early postoperative phase. The American College of Cardiology/ American Heart Association and European Society of Cardiology guidelines recommend the use of warfarin for the first three months after biological aortic valve replacement (BAVR), although the American College of Chest Physicians guidelines suggest that these recommendations are experience-based and that the risk/benefit is unclear. The aim of the present study was to compare the efficacy of aspirin and warfarin in patients after BAVR.
  
  
  
  A total of 863 patients who underwent BAVR between 2008 and 2015 was allocated to two groups. Each group was managed with a specific anticoagulation regimen, with 430 patients receiving warfarin during the first three postoperative months, and 433 receiving aspirin. The major study end points were bleeding, cerebral ischemic events, and survival.
  
  
  
  In total, 10 and 15 postoperative cerebral ischemic events occurred between 24 h and three months after surgery in patients treated with aspirin and warfarin, respectively. After three months the incidence of cerebral ischemic events did not differ greatly between the two groups. The rate of major bleeding events and rates of stroke-free survival and overall survival were not statistically significant between the warfarin and aspirin groups.
  
  
  
  Plasma anticoagulation with warfarin during the early postoperative phase was shown statistically to be inferior to platelet aggregation inhibition by aspirin with regards to postoperative bleeding risk, cerebral ischemic events, and survival.
authors.affiliation: Department of Cardiac Surgery and Cardiology, Central Clinic of Bad Berka, Germany.
authors.forename: Tamer
authors.initials: T
authors.lastname: Owais
authors.affiliation: Department of Cardiac Surgery and Cardiology, Central Clinic of Bad Berka, Germany.
authors.forename: Mina
authors.initials: M
authors.lastname: Rouman
authors.affiliation: Department of Cardiac Surgery and Cardiology, Central Clinic of Bad Berka, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Breuer
authors.affiliation: Department Anaesthesiology and Intensive Medicine, Central Clinic of Bad Berka, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hüter
authors.affiliation: Department Anaesthesiology and Intensive Medicine, Central Clinic of Bad Berka, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Fuchs
authors.affiliation: Department of Cardiac Surgery and Cardiology, Central Clinic of Bad Berka, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.affiliation: Department of Cardiac Surgery and Cardiology, Central Clinic of Bad Berka, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001021:Aortic Valve / Q000601:surgery*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D001705:Bioprosthesis; D001777:Blood Coagulation / Q000187:drug effects*; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011474:Prosthesis Design; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin