Association of Antiplatelet and Anticoagulant Treatment in Patients with Mechanical Prosthetic Heart Valves. Data from the Observational Multicentre PLECTRUM Study (original) (raw)
Association of antiplatelet and anticoagulant treatment in patients with Mechanical Prosthetic Heart Valves. Data from the observational multicentre PLECTRUM Study. Cardiology and Cardiovascular Medicine 5 (2021): 123-133. Abstract Background: Patients with a mechanical pros-thetic heart valve (MHV) need vitamin K antagonist (VKA) treatment, due to the high thrombotic risk. Guidelines disagree in relation to the need of low-dose aspirin associated treatment (VKA+apl). In the dataset of PLECTRUM study, we evaluate the number and characteristics of patients treated with VKA+apl, their bleeding and thrombotic risk. Methods: Observational retrospective multicenter study among Centers affiliated to the Italian Results: 237/2051 (11.5%) enrolled patients were treated with VKA + apl. These patients were older than patients on single VKA treatment, more frequently males, have a higher rate of cardiovascular risk factors, higher prevalence of coronary artery disease, peripheral arterial obstructive disease, Stroke/transient ischemic attack (TIA), heart failure, and atrial fibrillation. Instead, no difference was found between patients on VKA and patients on VKA + apl in relation to the site of valvular implantation (aortic, mitralic or mitro-aortic) and to the intensity of anticoagulation. The rate of major bleedings, of Stroke/TIA and of death were higher in patients on VKA +apl with respect to patients treated with VKA. Conclusions: Patients with MHV followed in Italian Anticoagulation Clinics usually receive single VKA treatment. VKA +apl is limited to patients with concomitant arterial disease or at high cardiovascular risk. VKA +apl did not reduce the stroke risk of these patients and is associated with a trend to an increased bleeding risk.
Journal of Thrombosis and Thrombolysis, 2011
Patients with prosthetic heart valves require chronic oral anticoagulation. In this clinical scenario, physicians must be mindful of the thromboembolic and bleeding risks related to chronic anticoagulant therapy. Currently, only vitamin K antagonists are approved for this indication. This paper reviews the main heart valve guidelines focusing on the use of oral anticoagulation in these patients.
Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves
Journal of Cardiac Surgery, 2020
Background: The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature. Antithrombotic therapies are used after heart valve intervention to reduce the rates of thromboembolic events, therefore improving patient outcomes. Different interventions may require different therapeutic regimens to achieve the most efficacious clinical outcome for patients. Methods and Discussion: This review aims to summarize and critique the available literature concerning therapeutic agents used for bioprosthetic and mechanical valves as well as for valve repair, so as to assist clinicians and researchers in making decisions with regard to their patients and research endeavors.
Open heart, 2018
Several factors should be considered when a prosthetic heart valve, bioprosthetic valve (BV) or mechanical valve is to be implanted: thrombogenicity, life expectancy and the risk of reoperation. We conducted an observational retrospective multicentre study among Italian Thrombosis Centers on patients with BV on long-term vitamin K antagonist (VKA) treatment to evaluate the risk of reoperation and the rate of bleeding and thrombotic events. We analysed 612 patients (median age 71.8 years) with BV on long-term VKA treatment for the presence of atrial fibrillation (AF) (78.4%) or other indications (21.6%). Thirty-four major bleeding events (rate 1.1×100 patient-years) and 29 thromboembolic events (rate 0.9×100 patient-years) were recorded, and 46 patients (rate 1.5×100 patient-years) underwent reoperation. The rate of reoperation was higher among younger patients: 32.9% in patients <60 years and 3.9% in patients ≥60 years (relative risk (RR) 3.8, 95% CI 2.1 to 7.2; p=0.0001). When p...
SAGE Open Medicine, 2016
Background: The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding. Objectives: The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position. Methods: Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case. Results: We collected data from 1...
Frontiers in Cardiovascular Medicine
BackgroundDirect oral anticoagulants are efficient alternatives to vitamin K antagonists. There is little evidence regarding their use in patients who underwent bioprosthetic valve replacement whether surgically or through a transcatheter approach and have another indication of anticoagulation. Trials have compared different members of the DOACs family to VKAs and showed that they were at least non-inferior to VKAs with regard to safety and efficacy. However, this is still controversial. Our meta-analysis aims at providing a clearer view of their future use in this subgroup of patients.MethodsPubMed and Cochrane were searched for randomised clinical trials and observational studies. Bleeding, stroke, and all-cause mortality were the outcomes of interest.ResultsTen papers with a total of 4,088 patients were included. Our meta-analysis revealed no significant differences between the incidence of bleeding between DOACs and warfarin (16% vs. 17%, OR = 0.94, 95% CI [0.56–1.57], p = 0.81,...
Predictors of Optimum AntiCoagulation in a Mechanical Heart Valve Replacement Population
2021
Background: Patients with a mechanical heart valve(MHV) are at increased risk of thrombosis, requiring life-long anti-coagulation with warfarin. Time in therapeutic range (TTR) is a marker of quality of anti-coagulation. The aim of this study was to assess the success of a nurse-administered warfarin anti-coagulation programme and identify predictors of optimum anti-coagulation. Methods: We performed a cross-sectional study in 270 adults with MHV (mean age 54±13.3, females n = 115), followed in a nurseled anti-coagulation clinic at King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia, between January 2015 and December 2017. Clinical charecteristics were compared between patients with a TTR < 70% and ≥ 70%. Data was analysed using JMP Version 13 Pro (SAS for Windows), p < 0. 05 considered significant. Results: Mean TTR was 65 ± 17%, with 60% of patients achieving a subtherapeutic TTR of < 70. TTR < 70% was associated with higher INR target of 2.5 3.5 (72% vs. 39%, p < ...