Antithrombotic therapy after bioprosthetic aortic valve replacement: ACTION Registry survey results

• Published in: European journal of cardio-thoracic surgery 2008-04, Vol.33 (4), p.531-536
• Main Authors: Colli, Andrea, Verhoye, Jean-Philippe, Heijmen, Robin, Strauch, Justus Thomas, Hyde, Jonathan A.J., Pagano, Domenico, Antunes, Manuel, Koertke, Heinrich, Ohri, Sunil Kumar, Bail, Dorothee Helene Lina, Leprince, Pascal, Van Straten, Bart H.M., Gherli, Tiziano
• Format: Article
• Language: English
• Subjects: Acetyl salicylic acid; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Antiplatelet drugs; Antithrombotic therapy; Aortic bioprosthetic valve; Biological and medical sciences; Bioprosthesis; Cardiology. Vascular system; Clinical Protocols; Health Care Surveys; Heart Valve Diseases - drug therapy; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Humans; Medical sciences; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Pneumology; Postoperative Complications - prevention & control; Practice Guidelines as Topic; Registries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2007.12.019

Aims: A variety of antithrombotic regimens have been described for the early postoperative period after bioprosthetic aortic valve replacement (AVR). This study reviews antithrombotic practice for patients undergoing bioprosthetic AVR with or without coronary artery bypass graft (CABG) amongst the centers participating in the ACTION (Anticoagulation Treatment Influence on Postoperative Patients) Registry. Methods and results: An antithrombotic therapy questionnaire was answered by the 49 centers participating in the ACTION Registry located in Europe, Middle East, Canada and Asia. The 43% of centers prescribe vitamin K antagonist (VKA), 20% prescribe VKA and acetyl salicylic acid (ASA), 33% prescribe only ASA and 4% do not prescribe any therapy after bioprosthetic AVR. For patients undergoing bioprosthetic AVR and CABG 39% of the centers prescribe VKA and ASA, 37% prescribe VKA and 24% prescribe ASA. After the first three postoperative months following bioprosthetic AVR, 61% of the centers prescribe only ASA, while 39% do not prescribe any therapy. Patients with bioprosthetic AVR and CABG receive ASA in 90% centers, in 2% centers VKA and ASA, and 8% centers do not prescribe any antithrombotic. Conclusion: This study demonstrates that, despite guidelines published by several professional societies, medical practice for the prevention of thrombotic events early after bioprosthetic AVR varies widely among cardiac surgical centers.