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How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review.

Publication ,  Journal Article
Eikelboom, R; Whitlock, RP; Lopes, RD; Siegal, D; Jaffer, IH; Drakos, P; Schulman, S; Belley-Côté, EP
Published in: Thromb Haemost
January 2023

IMPORTANCE:  Aortic stenosis is the most common valvular disease, and more than 90% of patients who undergo aortic valve replacement receive a bioprosthetic valve. Yet optimal antithrombotic therapy after bioprosthetic aortic valve replacement remains uncertain, and guidelines provide contradictory recommendations. OBSERVATIONS:  Randomized studies of antithrombotic therapy after bioprosthetic aortic valve replacement are small and underpowered. Observational data present opposing, and likely confounded, results. Historically, changes to guidelines have not been informed by high-quality new data. Current guidelines from different professional bodies provide contradictory recommendations despite citing the same evidence. CONCLUSION:  Insufficient antithrombotic therapy after bioprosthetic aortic valve replacement has serious implications: ischemic stroke, systemic arterial thromboembolism, and clinical and subclinical valve thromboses. Unnecessarily intense antithrombotic therapy, however, increases risk of bleeding and associated morbidity and mortality. Professional bodies have used the current low-quality evidence and generated incongruent recommendations. Researchers should prioritize generating high-quality, randomized evidence evaluating the risks and benefits of antiplatelet versus anticoagulant therapy after bioprosthetic aortic valve replacement.

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Published In

Thromb Haemost

DOI

EISSN

2567-689X

Publication Date

January 2023

Volume

123

Issue

1

Start / End Page

6 / 15

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • Aortic Valve
  • Anticoagulants
  • 3202 Clinical sciences
 

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Eikelboom, R., Whitlock, R. P., Lopes, R. D., Siegal, D., Jaffer, I. H., Drakos, P., … Belley-Côté, E. P. (2023). How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review. Thromb Haemost, 123(1), 6–15. https://doi.org/10.1055/s-0042-1758128
Eikelboom, Rachel, Richard P. Whitlock, Renato D. Lopes, Deborah Siegal, Iqbal H. Jaffer, Paul Drakos, Sam Schulman, and Emilie P. Belley-Côté. “How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review.Thromb Haemost 123, no. 1 (January 2023): 6–15. https://doi.org/10.1055/s-0042-1758128.
Eikelboom R, Whitlock RP, Lopes RD, Siegal D, Jaffer IH, Drakos P, et al. How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review. Thromb Haemost. 2023 Jan;123(1):6–15.
Eikelboom, Rachel, et al. “How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review.Thromb Haemost, vol. 123, no. 1, Jan. 2023, pp. 6–15. Pubmed, doi:10.1055/s-0042-1758128.
Eikelboom R, Whitlock RP, Lopes RD, Siegal D, Jaffer IH, Drakos P, Schulman S, Belley-Côté EP. How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review. Thromb Haemost. 2023 Jan;123(1):6–15.
Journal cover image

Published In

Thromb Haemost

DOI

EISSN

2567-689X

Publication Date

January 2023

Volume

123

Issue

1

Start / End Page

6 / 15

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • Aortic Valve
  • Anticoagulants
  • 3202 Clinical sciences