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

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

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.

Publication types

  • Classical Article
  • Comparative Study
  • Multicenter Study

MeSH terms

  • Administration, Oral
  • Adult
  • Age Factors
  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Cohort Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / methods
  • Hemorrhage / chemically induced
  • Hemorrhage / prevention & control*
  • Humans
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / surgery*
  • Multivariate Analysis
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Aggregation Inhibitors / adverse effects
  • Postoperative Complications / drug therapy
  • Postoperative Complications / prevention & control
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Statistics, Nonparametric
  • Survival Rate
  • Thromboembolism / drug therapy
  • Thromboembolism / prevention & control*
  • Treatment Outcome
  • Ultrasonography
  • Vitamin K / administration & dosage
  • Vitamin K / antagonists & inhibitors

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Vitamin K