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Antithrombotic therapy after heart valve surgery: contemporary practice in the UK.
Laskar, Nabila; Bayliss, Christopher D; Kirmani, Bilal H; Chambers, John B; Maier, Rebecca; Briffa, Norman P; Cartwright, Neil; Kendall, Simon; Shah, Benoy Nalin; Akowuah, Enoch.
Afiliación
  • Laskar N; Department of Cardiology, Barts Heart Centre, London, UK.
  • Bayliss CD; Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
  • Kirmani BH; Department of Cardiac Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK.
  • Chambers JB; Department of Cardiology, Guys & St Thomas' Hospitals, London, UK.
  • Maier R; Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
  • Briffa NP; Department of Cardiac Surgery, Northern General Hospital, Sheffield, UK.
  • Cartwright N; Department of Cardiac Surgery, Northern General Hospital, Sheffield, UK.
  • Kendall S; Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
  • Shah BN; Department of Cardiology, Wessex Cardiac Centre, Southampton General Hospital, Southampton, UK.
  • Akowuah E; Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
Interdiscip Cardiovasc Thorac Surg ; 38(5)2024 May 02.
Article en En | MEDLINE | ID: mdl-38704867
ABSTRACT

OBJECTIVES:

There is a lack of high-quality data informing the optimal antithrombotic drug strategy following bioprosthetic heart valve replacement or valve repair. Disparity in recommendations from international guidelines reflects this. This study aimed to document current patterns of antithrombotic prescribing after heart valve surgery in the UK.

METHODS:

All UK consultant cardiac surgeons were e-mailed a custom-designed survey. The use of oral anticoagulant (OAC) and/or antiplatelet drugs following bioprosthetic aortic valve replacement or mitral valve replacement, or mitral valve repair (MVrep), for patients in sinus rhythm, without additional indications for antithrombotic medication, was assessed. Additionally, we evaluated anticoagulant choice following MVrep in patients with atrial fibrillation.

RESULTS:

We identified 260 UK consultant cardiac surgeons from 36 units, of whom 103 (40%) responded, with 33 units (92%) having at least 1 respondent. The greatest consensus was for patients undergoing bioprosthetic aortic valve replacement, in which 76% of surgeons favour initial antiplatelet therapy and 53% prescribe lifelong treatment. Only 8% recommend initial OAC. After bioprosthetic mitral valve replacement, 48% of surgeons use an initial OAC strategy (versus 42% antiplatelet), with 66% subsequently prescribing lifelong antiplatelet therapy. After MVrep, recommendations were lifelong antiplatelet agent alone (34%) or following 3 months OAC (20%), no antithrombotic agent (20%), or 3 months OAC (16%). After MVrep for patients with established atrial fibrillation, surgeons recommend warfarin (38%), a direct oral anticoagulant (37%) or have no preference between the 2 (25%).

CONCLUSIONS:

There is considerable variation in the use of antithrombotic drugs after heart valve surgery in the UK and a lack of high-quality evidence to guide practice, underscoring the need for randomized studies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido