Vol. 47 | No. 1 | January-June 2019 Back

Open Access

Anticoagulation with Vitamin K Antagonists Versus Antiplatelet Therapy After Surgical Bioprosthetic Valve Implantation in the Prevention of Thromboembolism: A Meta-Analysis of Randomized Controlled Trials

Ferdinand Gerodias Jr., Sue Ann Locnen, Anthony Gerodias, Jay Datukan, Patricia Mariano
Jun 2019 DOI 10.69944/pjc.2755442f19

Abstract

BACKGROUND: The optimum medical therapy in the first three months after surgical  bioprosthetic valve implantation (BVI) remains controversial. Current guidelines of the American  College of Cardiology recommend either anticoagulation with vitamin K antagonists (VKA) (level IIa)  or antiplatelet (AP) using aspirin (level IIa) after surgery, which is based on non-randomized studies.  Hence, we performed a meta-analysis of randomized controlled trials (RCT) comparing the efficacy  and safety of VKA vs AP therapy early after surgical BVI. 

METHODS: An extensive search of PubMed, Medline, Cochrane and Ovid was performed for  RCTs comparing VKA vs AP therapy among adult patients who underwent surgical BVI. Outcome  measures for thromboembolism, all-cause mortality and major bleeding were extracted and  analyzed using a random effect model via Review Manager V5.3. 

RESULTS: Three RCTs with 590 patients were included. There were no differences in the rates  of thromboembolic events (5% vs 6.8%; p=0.37) or all-cause mortality (4.7% vs 5.8% p=0.64)  between the VKA vs AP groups There was a higher incidence of major bleeding in the VKA group  (6% vs 2.4%), which was statistically significant (OR 2.63 (95% CI 1.08–6.43; p=0.03)).  

CONCLUSION: Vitamin K antagonist and AP therapies have similar rates of thromboembolic  events and all-cause mortality in the first three months among patients post-surgical BVI. However,  VKAs have a significantly higher incidence of major bleeding, which suggests that AP therapy may  be the preferable strategy for anticoagulation in BVI post-surgery. 

KEYWORDS: Prosthetic heart valve, Anticoagulation, Antiplatelet therapy, Bioprosthetic Valve  Implantation 

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