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

D. paparella, M. Di Mauro, K. Bitton Worms, Gil Bolotin, C. Russo, Salvatore Trunfio, Roberto Scrofani, C. Antona, Guglielmo Actis Dato, R. Casabona, A. Colli, G. Gerosa, Attilio Renzulli, Francesca Serraino, G. Scrascia, S. Zaccaria, M. De Bonis, Maurizio Taramasso, L. Delgado, Francesco TrittoJ. Marmo, A. Parolari, Veronika Myasoedova, E. Villa, Giovanni Troise, F. Nicolini, T. Gherli, Richard Whitlock, M. Conte, Fabio Barili, Sandro Gelsomino, Rosaria Lorusso, Edoardo Sciatti, D. Marinelli, Gabriele Di Giammarco, A. M. Calafiore, A. Sheikh, P. J. Alfonso, Mattia Glauber, A. Miceli

Research output: Contribution to journalArticle

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. © 2016 The American Association for Thoracic Surgery.
Original languageEnglish
Pages (from-to)1302
Number of pages1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number5
DOIs
Publication statusPublished - 2016

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Keywords

  • anticoagulation
  • antiplatelet
  • bleeding
  • mitral valve repair
  • stroke
  • acetylsalicylic acid
  • anticoagulant agent
  • antithrombocytic agent
  • hemoglobin
  • vitamin K group
  • adult
  • anticoagulant therapy
  • Article
  • brain hemorrhage
  • brain ischemia
  • cohort analysis
  • controlled study
  • drug efficacy
  • drug safety
  • female
  • follow up
  • hemoglobin blood level
  • hospital discharge
  • human
  • incidence
  • intracardiac thrombosis
  • major clinical study
  • male
  • middle aged
  • mitral valve regurgitation
  • multicenter study (topic)
  • priority journal
  • retrospective study
  • sinus rhythm
  • thromboembolism
  • transient ischemic attack
  • treatment duration
  • treatment outcome
  • adverse effects
  • age
  • aged
  • antagonists and inhibitors
  • chemically induced
  • clinical trial
  • comparative study
  • echography
  • factual database
  • heart valve replacement
  • Hemorrhage
  • history
  • Mitral Valve Insufficiency
  • multicenter study
  • multivariate analysis
  • nonparametric test
  • oral drug administration
  • Postoperative Complications
  • predictive value
  • procedures
  • receiver operating characteristic
  • risk assessment
  • sex difference
  • subcutaneous drug administration
  • survival rate
  • Administration, Oral
  • Adult
  • Age Factors
  • Aged
  • Anticoagulants
  • Cohort Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation
  • Humans
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Platelet Aggregation Inhibitors
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • ROC Curve
  • Sex Factors
  • Statistics, Nonparametric
  • Survival Rate
  • Thromboembolism
  • Treatment Outcome
  • Vitamin K

Cite this

paparella, D., Di Mauro, M., Bitton Worms, K., 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., ... Miceli, A. (2016). Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair. Journal of Thoracic and Cardiovascular Surgery, 151(5), 1302. https://doi.org/10.1016/j.jtcvs.2015.12.036