Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair

Domenico Paparella, Michele Di Mauro, Keren Bitton Worms, Gil Bolotin, Claudio Russo, Salvatore Trunfio, Roberto Scrofani, Carlo Antona, Guglielmo Actis Dato, Riccardo Casabona, Andrea Colli, Gino Gerosa, Attilio Renzulli, Filiberto Serraino, Giuseppe Scrascia, Salvatore Zaccaria, Michele De Bonis, Maurizio Taramasso, Luis Delgado, Francesco Tritto & 20 others Joseph Marmo, Alessandro Parolari, Veronika Myaseodova, Emmanuel Villa, Giovanni Troise, Francesco Nicolini, Tiziano Gherli, Richard Whitlock, Manuela Conte, Fabio Barili, Sandro Gelsomino, Roberto Lorusso, Edoardo Sciatti, Daniele Marinelli, Gabriele Di Giammarco, Antonio Maria Calafiore, Azmat Sheikh, Juan Jaime Alfonso, Mattia Glauber, Antonio Miceli

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - Jun 9 2015

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Mitral Valve
Anticoagulants
Hemorrhage
Incidence
Vitamin K
Mortality
Platelet Aggregation Inhibitors
Therapeutics
Atrial Fibrillation
Cohort Studies
Randomized Controlled Trials
Safety

Keywords

  • Anticoagulation
  • Antiplatelet
  • Bleeding
  • Mitral valve repair
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair. / Paparella, Domenico; Di Mauro, Michele; Worms, Keren Bitton; Bolotin, Gil; Russo, Claudio; Trunfio, Salvatore; Scrofani, Roberto; Antona, Carlo; Actis Dato, Guglielmo; Casabona, Riccardo; Colli, Andrea; Gerosa, Gino; Renzulli, Attilio; Serraino, Filiberto; Scrascia, Giuseppe; Zaccaria, Salvatore; De Bonis, Michele; Taramasso, Maurizio; Delgado, Luis; Tritto, Francesco; Marmo, Joseph; Parolari, Alessandro; Myaseodova, Veronika; Villa, Emmanuel; Troise, Giovanni; Nicolini, Francesco; Gherli, Tiziano; Whitlock, Richard; Conte, Manuela; Barili, Fabio; Gelsomino, Sandro; Lorusso, Roberto; Sciatti, Edoardo; Marinelli, Daniele; Di Giammarco, Gabriele; Calafiore, Antonio Maria; Sheikh, Azmat; Alfonso, Juan Jaime; Glauber, Mattia; Miceli, Antonio.

In: Journal of Thoracic and Cardiovascular Surgery, 09.06.2015.

Research output: Contribution to journalArticle

Paparella, D, Di Mauro, M, Worms, KB, Bolotin, G, Russo, C, Trunfio, S, Scrofani, R, Antona, C, Actis Dato, G, Casabona, R, Colli, A, Gerosa, G, Renzulli, A, Serraino, F, Scrascia, G, Zaccaria, S, De Bonis, M, Taramasso, M, Delgado, L, Tritto, F, Marmo, J, Parolari, A, Myaseodova, V, Villa, E, Troise, G, Nicolini, F, Gherli, T, Whitlock, R, Conte, M, Barili, F, Gelsomino, S, Lorusso, R, Sciatti, E, Marinelli, D, Di Giammarco, G, Calafiore, AM, Sheikh, A, Alfonso, JJ, Glauber, M & Miceli, A 2015, 'Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2015.12.036
Paparella, Domenico ; Di Mauro, Michele ; Worms, Keren Bitton ; Bolotin, Gil ; Russo, Claudio ; Trunfio, Salvatore ; Scrofani, Roberto ; Antona, Carlo ; Actis Dato, Guglielmo ; Casabona, Riccardo ; Colli, Andrea ; Gerosa, Gino ; Renzulli, Attilio ; Serraino, Filiberto ; Scrascia, Giuseppe ; Zaccaria, Salvatore ; De Bonis, Michele ; Taramasso, Maurizio ; Delgado, Luis ; Tritto, Francesco ; Marmo, Joseph ; Parolari, Alessandro ; Myaseodova, Veronika ; Villa, Emmanuel ; Troise, Giovanni ; Nicolini, Francesco ; Gherli, Tiziano ; Whitlock, Richard ; Conte, Manuela ; Barili, Fabio ; Gelsomino, Sandro ; Lorusso, Roberto ; Sciatti, Edoardo ; Marinelli, Daniele ; Di Giammarco, Gabriele ; Calafiore, Antonio Maria ; Sheikh, Azmat ; Alfonso, Juan Jaime ; Glauber, Mattia ; Miceli, Antonio. / Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair. In: Journal of Thoracic and Cardiovascular Surgery. 2015.
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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.",
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AU - Paparella, Domenico

AU - Di Mauro, Michele

AU - Worms, Keren Bitton

AU - Bolotin, Gil

AU - Russo, Claudio

AU - Trunfio, Salvatore

AU - Scrofani, Roberto

AU - Antona, Carlo

AU - Actis Dato, Guglielmo

AU - Casabona, Riccardo

AU - Colli, Andrea

AU - Gerosa, Gino

AU - Renzulli, Attilio

AU - Serraino, Filiberto

AU - Scrascia, Giuseppe

AU - Zaccaria, Salvatore

AU - De Bonis, Michele

AU - Taramasso, Maurizio

AU - Delgado, Luis

AU - Tritto, Francesco

AU - Marmo, Joseph

AU - Parolari, Alessandro

AU - Myaseodova, Veronika

AU - Villa, Emmanuel

AU - Troise, Giovanni

AU - Nicolini, Francesco

AU - Gherli, Tiziano

AU - Whitlock, Richard

AU - Conte, Manuela

AU - Barili, Fabio

AU - Gelsomino, Sandro

AU - Lorusso, Roberto

AU - Sciatti, Edoardo

AU - Marinelli, Daniele

AU - Di Giammarco, Gabriele

AU - Calafiore, Antonio Maria

AU - Sheikh, Azmat

AU - Alfonso, Juan Jaime

AU - Glauber, Mattia

AU - Miceli, Antonio

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N2 - 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.

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KW - Anticoagulation

KW - Antiplatelet

KW - Bleeding

KW - Mitral valve repair

KW - Stroke

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