What is the clinical evidence from this study?

Study design: Observational. Population: Isolated aortic valve replacement with a mechanical valve (n=43). Intervention: Discontinuation of anticoagulation. Primary outcome: Thromboembolic events (linearized rate).

What does this research mean for the field?

Discontinuing anticoagulation after approximately 1 year in patients with mechanical aortic valves results in high linearized rates of thromboembolic events (5.2%/pt-yr) and death (2.9%/pt-yr), reinforcing the necessity of lifelong anticoagulation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 1, 1992

Long-term survival and complications in patients with mechanical aortic valves without anticoagulation A follow-up study from 1 to 15 years

Key Result

Discontinuing anticoagulation after approximately 1 year in patients with mechanical aortic valves resulted in linearized rates of thromboembolic events of 5.2%/pt-yr and death of 2.9%/pt-yr.

Study Design

Type

Observational (n=43)

Structured PICO

What is the long-term prognosis of patients with mechanical aortic valves who discontinue anticoagulation after approximately 1 year?

Population

43 patients (37 men, 6 women, mean age 52 years) who underwent isolated aortic valve replacement with a mechanical valve

Intervention

Discontinuation of anticoagulation after approximately 1 year (mean 13 months; range 4-35 months) post-surgery

Outcome

Thromboembolic events, valve-related events, and survival at 5 and 10 yearshard clinical

Discontinuing anticoagulation after mechanical aortic valve replacement leads to high rates of thromboembolic and valve-related events, supporting the need for lifelong anticoagulation.

Abstract

In aortic valve replacement most centres prefer to use a mechanical valve for younger patients without special bleeding risks and treat the patient with lifelong anticoagulation. However, a few patients do not receive anticoagulation at all or have this withdrawn after some time. We examined the prognosis of 43 patients, 37 men and 6 women (mean age 52 years), who were treated with anticoagulation for approximately only 1 year (mean 13 months; range 4-35 months) after isolated aortic valve replacement with a mechanical valve. The mean follow-up period was 7 years and 3 months (1.5 months to 15 years and 10 months). After 5 and 10 years, 70% and 59%, respectively, were free of thromboembolic events, 65% and 55%, respectively, were free of valve-related events, and 87% and 83%, respectively, had survived. These figures correspond to linearized rates of thromboembolic events of 5.2%/pt-yr, valve-related events of 6.2%/pt-yr and death of 2.9%/pt-yr. We conclude that the best postoperative treatment in isolated aortic valve replacement with a mechanical valve is lifelong anticoagulation.

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