Key result
Oral anticoagulation use after biologic aortic valve replacement was associated with an increased risk of stroke (HR 2.39) and a decreased risk of death (HR 0.79) compared to no anticoagulation.
Why the study?
Thromboembolism prophylaxis is recommended for 3 months after biologic aortic valve replacement, but the effect of continuing oral anticoagulation on long-term prognosis required examination.
Does oral anticoagulation treatment affect the risk of death, stroke, and major bleeding in individuals who underwent biologic aortic valve replacement?
Cohort (n=3,880)
Yes
Does oral anticoagulation treatment affect the risk of death, stroke, and major bleeding in individuals who underwent biologic aortic valve replacement?
In patients who underwent biologic aortic valve replacement, oral anticoagulation use was observationally associated with a decreased risk of death but an increased risk of stroke, highlighting the need for randomized controlled trials.
Answers are grounded in this paper and cite their sources.
OAC continuation after 3 months post-BAVR was associated with higher stroke but lower mortality risk; leaves open net benefit pending RCTs.
Objectives: Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for 3 months postoperatively. We examined the continuation of oral anticoagulation (OAC) treatment and its effect on the long-term prognosis after BAVR. Methods: We used nation-wide register data from 4,079 individuals who underwent BAVR. We examined the association between warfarin and the non-vitamin K antagonist oral anticoagulant use with death, stroke and major bleeding in 2010 – 2016. Results: The risk of stroke was higher (HR 2.39, 95% CI 1.62 – 3.53, p < 0.001) and the risk of death was lower (HR 0.79, 95% CI 0.65 – 0.96, p = 0.016) in OAC-users compared to individuals without OAC. We observed no significant associations between OAC use and bleeding risk. Conclusion: OAC use after BAVR was associated with increased risk of stroke and decreased risk of death. These observational findings warrant validation in randomized controlled trials before any clinical conclusions can be drawn.
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Myllykangas et al. (2021) conducted a cohort in Biologic aortic valve replacement (n=3,880). Oral anticoagulation (OAC) vs. No oral anticoagulation was evaluated on Stroke (HR 2.39, 95% CI 1.62-3.53, p=<0.001). Oral anticoagulation use after biologic aortic valve replacement was associated with an increased risk of stroke (HR 2.39) and a decreased risk of death (HR 0.79) compared to no anticoagulation.
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