Does antiplatelet therapy (aspirin) compared to anticoagulation provide safe and effective antithrombotic management in patients after bioprosthetic aortic valve replacement at low risk of thromboembolism?
A review of the literature suggests that aspirin alone, rather than anticoagulation, is the preferred antithrombotic strategy after bioprosthetic aortic valve replacement in low-risk patients.
There is a lack of consensus as to the ideal antithrombotic strategy after bioprosthetic aortic valve replacement. Herein, the authors review the literature on this topic and find that most of the evidence is comprised of small observational data, with a few prospective trials. The bulk of the evidence is in favor of no anticoagulation after bioprosthetic aortic valve replacement in patients at low risk of thromboembolism. Most studies suggest using only antiplatelet therapy with the exception of two studies that advocate anticoagulation. One study suggests that no antithrombotic therapy at all may be safe. One study evaluated the question mechanistically, showing no increased microembolic signals on transcranial Doppler in patients receiving aspirin compared to patients who were anticoagulated. Based on the evidence presented, the authors recommend using aspirin only after bioprosthetic aortic valve replacement in patients at low risk of thromboembolism.
Al‐Atassi et al. (Tue,) studied this question.
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