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Antithrombotic therapy after bioprosthetic aortic valve implantation: Warfarin versus aspirin, a randomized controlled trial

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BACKGROUND: The optimal medical strategy for prevention of thromboembolic events after surgical bioprosthetic aortic valve replacement (BAVR) is still debated. The objective of this study was to compare warfarin therapy (target INR of 2.0 to 3.0) with aspirin 150mg daily as antithrombotic therapy for the first three months after BAVR with or without concomitant coronary artery bypass grafting (CABG). The aim was to evaluate thromboembolic complications, major bleeding complications and death.

MATERIALS AND METHODS: Prospective, single-centre, open-label, randomized controlled trial. 370 patients were enrolled, 328 were available for data analysis.

RESULTS: At baseline the warfarin and aspirin groups were comparable. Thromboembolic events were comparable between groups 11 (6.6%) vs. 12 (7.5%), p=0.83. Major bleeding events occurred numerically more often in warfarin patients 9 (5.4%) vs. 3 (1.9%), p=0.14. Warfarin was in multivariate analysis significantly associated with major bleeding OR 5.18 (CI 1.06-25.43), p=0.043. 90-day mortality was comparable between groups 8 (4.7%) vs. 6 (3.7%), p=0.79.

CONCLUSIONS: Our results suggest that aspirin might be equally effective as warfarin in preventing thromboembolic events after BAVR, but with less major bleedings. Although this is numerically the largest trial testing this hypothesis in a prospective randomized trial, further adequately powered studies are warranted.

Original languageEnglish
JournalThrombosis Research
Volume150
Pages (from-to)104-110
Number of pages7
ISSN0049-3848
DOIs
Publication statusPublished - Feb 2017

    Research areas

  • Aged, Aged, 80 and over, Anticoagulants, Aortic Valve, Aspirin, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Hemorrhage, Humans, Postoperative Complications, Prospective Studies, Thromboembolism, Thrombosis, Warfarin, Journal Article, Randomized Controlled Trial

ID: 52051204