Key result
Concurrent therapy with aspirin and warfarin after bioprosthetic aortic valve replacement increased the risk of clinically relevant bleeding compared to aspirin alone (aHR 2.33; 95% CI 1.67-3.25).
Why the study?
Patients undergoing surgical bAVR have an elevated risk of postoperative thromboembolic events, but the risks and benefits of varying anticoagulation strategies remain controversial.
Does concurrent therapy (aspirin plus warfarin) reduce thromboembolic events or mortality compared to aspirin monotherapy in patients receiving bioprosthetic aortic valve replacement?
Cohort (n=3,047)
Does concurrent therapy (aspirin plus warfarin) reduce thromboembolic events or mortality compared to aspirin monotherapy in patients receiving bioprosthetic aortic valve replacement?
Discharging post-bAVR patients on aspirin plus warfarin increases bleeding risk without providing a significant thromboembolic or mortality benefit at 6 months compared to aspirin alone.
Concurrent therapy after bAVR was associated with higher bleeding; leaves open net benefit versus aspirin alone in observational data.
BACKGROUND AND AIM: Among patients receiving surgical bioprosthetic aortic valve replacement (bAVR), there is an elevated risk of thromboembolic events postoperatively. However, the risks and benefits of varying anticoagulation strategies remain controversial. The aim of this study is to compare the risks and benefits of aspirin monotherapy to aspirin plus warfarin ("concurrent therapy") in patients receiving bAVR. METHODS: A retrospective cohort study was conducted using patients' data from Kaiser Permanente Northern California, including those who underwent bAVR with or without coronary artery bypass grafting between 2009 and 2018. Patients were identified as having been discharged with aspirin only or concurrent therapy. The outcomes were mortality, thromboembolic events, and clinically relevant bleeding during a 6-month follow-up. The event rates were compared using the Kaplan-Meier method. Multivariable survival analysis, incorporating propensity scores, was used to estimate adjusted hazard ratios (aHRs) for each outcome. RESULTS: The cohort consisted of 3047 patients. Approximately 58% of patients received aspirin only and 42% received concurrent therapy. Patients who received concurrent therapy were more likely to be older, have hypertension, previous stroke, and longer hospital stays. After adjustment using multivariable analysis, concurrent therapy was associated with a higher risk of clinically relevant bleeding (aHR, 2.33; 95% confidence interval, 1.67-3.25). There was no significant difference in the risk of thromboembolic events or mortality between the two groups. CONCLUSION: Patients who underwent bAVR and were discharged on concurrent therapy compared to aspirin only had a significantly increased risk of bleeding without a significant difference in thromboembolic events.
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Yaghi et al. (2021) conducted a cohort in Surgical bioprosthetic aortic valve replacement (bAVR) (n=3,047). Aspirin plus warfarin (concurrent therapy) vs. Aspirin monotherapy was evaluated on Clinically relevant bleeding (aHR 2.33, 95% CI 1.67-3.25). Concurrent therapy with aspirin and warfarin after bioprosthetic aortic valve replacement increased the risk of clinically relevant bleeding compared to aspirin alone (aHR 2.33; 95% CI 1.67-3.25).
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