Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial (ANTIPRO)

• Published in: European journal of cardio-thoracic surgery 2022-12, Vol.63 (1)
• Main Authors: Fernandez, Amparo, Loza, Gimena, Parma, Gabriel, Florio, Lucia, Estigarribia, Jorge, Soca, Gerardo, Robaina, Ricardo, Duran, Ariel, Brusich, Daniel, Dayan, Victor
• Format: Article
• Language: English
• Subjects: Animals; Anticoagulants - therapeutic use; Aortic Valve - surgery; Aspirin - therapeutic use; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Hemorrhage - epidemiology; Hemorrhage - prevention & control; Prospective Studies; Swine; Treatment Outcome
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezac507

Most evidence for anticoagulation (AC) in aortic bioprosthesis is centred on embolic events, bleeding and reintervention risk. The effect of AC on haemodynamics has not been previously assessed. Our hypothesis was that patients with early AC after aortic valve replacement (AVR) with porcine bioprosthesis have better haemodynamics at 1 year of follow-up. Prospective, randomized, open-label trial conducted at 2 cardiac surgery centres. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The anticoagulated group received warfarin + aspirin and the non-anticoagulated (control) only aspirin. The primary outcome was mean gradient after 1 year of AVR and change in New York Heart Association class. Secondary outcomes were major and minor bleeding, embolic events and prosthetic leak. Of 140 participants in the study, 71 were assigned to the anticoagulated group and 69 to the control group. The mean age of the overall population was 72.4 (SD: 7.1) years. Global EuroSCORE was 7.65 (SD: 5.73). At 1 year, the mean gradient was similar between both groups [18.6 (SD: 1.1 mmHg) and 18.1 (SD: 1.0 mmHg) in the control and anticoagulated groups, respectively, P = 0.701]. No differences in functional class at 3 months or 1 year were found among groups. No differences were found among groups in the secondary outcomes. The addition of 3 months of oral AC to anti-aggregation treatment was not detected to affect bioprosthetic haemodynamics nor functional class at 1 year after AVR. Likewise, AC does not lead to the higher incidence of complications.