How Did We Get Here? Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Review.
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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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
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
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