Cardiovascular Diseases and Cardiac Surgery

Overview

Juan A. Crestanello, M.D., is a cardiovascular surgeon and department chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello, who specializes in surgery for valvular heart disease, discusses the guidelines for anticoagulation after bioprosthetic aortic valve replacement.

JUAN A. CRESTANELLO: Welcome to the Cardiovascular Surgery Series where I discuss the latest research in cardiovascular surgery from the Mayo Clinic. I will discuss today anticoagulation after bioprosthetic aortic valve replacement. Are we following the guidelines? The guidelines from the American Heart Association and the American College of Cardiology recommend anticoagulation after bioprosthetic surgical aortic valve replacement with a vitamin antagonist for three to six months in patients who are at low risk for bleeding.

We examined the Optum Data Warehouse between 2007 to 2019 for patients who received bioprosthetic aortic valve replacements. There were 10,730 patients. 29% of the patients received early anticoagulation for a median of 4.5 months. The rate of anticoagulation did not change during the period of the study.

Patients who received anticoagulation, they were more often male, white, had a history of atrial fibrillation, hyperlipidemia, congestive heart failure, chronic lung disease, PE, and venous thromboembolism history. They also have a CHA2DS2-VASc score greater or equal than two. Among patients at low risk of bleeding, only 11 patients-- 11% of the patients received anticoagulation between three and six months after the surgery.

We conclude that anticoagulation after surgical aortic valve replacement with a bioprosthesis as reflected by Coumadin prescriptions may be underused. The rates of anticoagulation have not changed in the last decade. Although additional studies are needed to confirm the benefit of early anticoagulation after surgical aortic valve replacement with a bioprosthesis, these results indicate that most physicians do not follow the guidelines. These findings highlight a potential area for improvement after surgical aortic valve replacement. Thank you for listening to the Cardiovascular Surgery Series.