Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement

J Am Coll Cardiol. 2019 Sep 3;74(9):1190-1200. doi: 10.1016/j.jacc.2019.06.058.

Abstract

Background: There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes.

Objectives: The study aimed to assess the impact of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes.

Methods: Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively.

Results: A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 0.17; 95% confidence interval [CI]: 0.05-0.60; p = 0.006).

Conclusions: In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined. (Placement of AoRTic TraNscathetER Valves [PARTNERII A]; NCT01314313).

Keywords: anticoagulation; bioprosthetic aortic valve replacement; transcatheter aortic valve replacement.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / pharmacology*
  • Anticoagulants / therapeutic use
  • Aortic Valve / drug effects*
  • Aortic Valve / physiology*
  • Aortic Valve / surgery
  • Bioprosthesis*
  • Female
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis*
  • Hemodynamics / drug effects*
  • Humans
  • Male
  • Postoperative Period
  • Prospective Studies
  • Transcatheter Aortic Valve Replacement
  • Treatment Outcome

Substances

  • Anticoagulants

Associated data

  • ClinicalTrials.gov/NCT01314313