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J Thorac Cardiovasc Surg. 2016 May;151(5):1302-8.e1. doi: 10.1016/j.jtcvs.2015.12.036. Epub 2016 Jan 5.

Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair.

Author information

1
U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy. Electronic address: domenico.paparella@uniba.it.
2
U.O. Cardiologia Università dell'Aquila, Italy.
3
Department of Cardiac Surgery, Rambam Medical Centre, Haifa, Israel.
4
U.O. Cardiochirurgia Ospedale Niguarda Milano, Italy.
5
U.O. di Chirurgia Cardiovascolare, Ospedale Polo Universitario Luigi Sacco, Milano, Italy.
6
U.O. Cardiochirurgia, Ospedale Mauriziano, Torino, Italy.
7
U.O. di Cardiochirurga, Dipartimento di Scienze Cardio-toraco-vascolare, Università di Padova, Italy.
8
Divisione di Cardiochirurgia, Università della Magna Grecia, Catanzaro, Italy.
9
U.O. Cardiochirurgia, Ospedale Vito Fazzi, Lecce, Italy.
10
U.O. Cardiochirurgia, Ospedale San Raffele, Milano, Italy.
11
Ospedale Universitario Germans Trias Y Pujol, Badalona, Spagna.
12
U.O. Cardiochirurgia, Ospedale S. Anna E S. Sebastiano, Caserta, Italy.
13
Divisione di Cardiochirurgia, IRCCS San Donato, San Donato Milanese, Italy.
14
Unità di Ricerca Clinica in Aterotrombosi, Centro Cardiologico Monzino, Milano, Italy.
15
Divisione di cardiochirurgia, Ospedale Poliambulanza, Brescia, Italy.
16
Unità di Cardiochirurgia, Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy.
17
Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada.
18
U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy.
19
Division of Cardiac Surgery, Santa Croce hospital, Cuneo, Italy.
20
Experimental Surgery, Heart and Vessels Department, Careggi Hospital, Firenze, Italy.
21
U.O. Cardiochirurgia, Spedali Civili, Brescia, Italy.
22
U.O. di Cardiochirurgia, Università di Chieti, Chieti, Italy.
23
Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
24
U.O. Cardiochirurgia, Ospedale Monasterio, Massa, Italy.

Abstract

OBJECTIVE:

To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome.

METHODS:

Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 ± 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286).

RESULTS:

No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P = .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P = .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P = .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months.

CONCLUSIONS:

Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.

KEYWORDS:

anticoagulation; antiplatelet; bleeding; mitral valve repair; stroke

Comment in

PMID:
26832208
DOI:
10.1016/j.jtcvs.2015.12.036
[Indexed for MEDLINE]
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