Key result
Short-term oral anticoagulation after surgical bioprosthetic aortic valve replacement was associated with lower all-cause mortality (aHR 0.488; 95% CI 0.259-0.919).
Why the study?
Short-term oral anticoagulation is recommended after surgical bioprosthetic aortic valve replacement, but the potential clinical benefits remain controversial.
Does short-term oral anticoagulation reduce all-cause mortality and bioprosthetic valve dysfunction in patients following surgical bioprosthetic aortic valve replacement?
Cohort (n=450)
Does short-term oral anticoagulation reduce all-cause mortality and bioprosthetic valve dysfunction in patients following surgical bioprosthetic aortic valve replacement?
Short-term oral anticoagulation after surgical bioprosthetic aortic valve replacement is associated with reduced all-cause mortality without increasing the risk of intracranial hemorrhage.
Short-term OAC after bAVR was associated with lower mortality; leaves open whether routine use improves net outcomes in randomized trials.
BACKGROUND: Short-term oral anticoagulation (OAC) is recommended for patients after surgical bioprosthetic aortic valve replacement (bAVR); however, the potential benefits remain controversial. This study evaluated the effects of short-term OAC following bAVR. METHODS: From 2010 to 2017, total 450 patients who underwent bAVR were enrolled. The outcomes of patients who did (OAC group) and who did not receive OAC (without-OAC group) after bAVR were compared. Propensity-score matching (PSM) was used to adjust for potential confounders, and a 1:1 matched cohort was formed. The main outcomes were all-cause mortality and bioprosthetic valve dysfunction (BVD). RESULTS: A total of 175 (39%) patients received OAC after bAVR. The median follow-up period was 2.9 years, the median duration of OAC use was 4 months; 162 pairs of patients were identified after the PSM. There was no significant difference in the prevalence of 1-year embolism/ischemic stroke between the OAC and without-OAC group in PSM cohort (0.62% vs. 1.89% for embolism, p = 0.623; 0 vs. 1.23% for ischemic stroke, p = 0.499). The prevalence of 1-year intracranial hemorrhage (ICH) between OAC and without-OAC group was also comparable (0.62% vs. 0.62%, p = 1). The OAC group had a lower all-cause mortality (adjusted hazard ratio (aHR):0.488, 95% confidence interval (CI): 0.259-0.919). There was also a trend for reduced BVD in the OAC group (aHR: 0.661, 95% CI: 0.339-1.290). CONCLUSION: Our study demonstrated that short-term OAC use after bAVR was associated with lower all-cause mortality. The prevalence of 1-year embolism/ischemic stroke/ICH were comparable despite of OAC use.
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Ko et al. (2022) conducted a cohort in Surgical bioprosthetic aortic valve replacement (n=450). Short-term oral anticoagulation (OAC) vs. No oral anticoagulation was evaluated on All-cause mortality (aHR 0.488, 95% CI 0.259-0.919). Short-term oral anticoagulation after surgical bioprosthetic aortic valve replacement was associated with lower all-cause mortality (aHR 0.488; 95% CI 0.259-0.919).
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