Long-term Outcomes of Patients without Anticoagulation Therapy after Prosthetic Aortic Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANGHuan-lei ¹ , LIUXiao-yuan ² , LUCong ¹ , GUOHui-ming ¹ , XIAOXue-jun ¹ , WURuo-bin ¹ ,  CHENJi-mei ¹ , ZHUANGJian ¹

1. Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, P. R. China;
2. Health Section of Military Band of People's Liberation Army, Beijing 100089, P. R. China;

Corresponding author：

CHENJi-mei, Email: jimei1965@gmail.com

Keywords：

Aortic valve replacement; Prosthetic valve; Anticoagulant therapy

DOI：

10.7507/1007-4848.20140047

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate long-term outcomes of patients without warfarin anticoagulation after isolated prosthetic aortic valve replacement (AVR) and evaluate the feasibility of short-term instead of lifelong anticoagulation therapy for low-risk AVR patients. Methods Seven patients who underwent prosthetic AVR in Guangdong General Hospital between 1996 and 1999 but discontinued warfarin anticoagulation 3 years after surgery were regularly followed up. There were 6 male and 1 female patients with their age of 25-75 (40.0±11.4) years. These patients received warfarin anticoagulation during the first 3 years after surgery but discontinued oral anticoagulant 3 years after surgery (discontinued anticoagulation group). Fifteen patients who underwent prosthetic AVR during the same period and continued warfarin anticoagulation were enrolled as the control group (continuing anticoagulation group). International normalized ratio (INR) was set between 1.8 and 2.5 during warfarin anticoagulation period in both groups. Survival rate and the incidence of severe adverse events were compared between the 2 groups. Results In the discontinued anticoagulation group,1 patient was lost during follow-up. No thromboembolic event,death or prosthetic valve thrombosis was observed. All the patients were in NYHA class Ⅰ. In the continuing anticoagulation group,3 patients were lost during follow-up. Eleven patients were in NYHA class Ⅰ and 2 patients were in NYHA class Ⅱ. Severe anticoagulation-related bleeding events occurred in 3 patients with gastrointestinal bleeding. One patient died of massive outbreak of vomiting blood,and another patient had sudden death. Ten-year survival rate was 100.0% and 86.7% in the discontinued anticoagulation group and continuing anticoagulation group, respectively. Conclusion For low-risk patients after isolated prosthetic AVR,short-term warfarin anticoagulation may be acceptable, which means warfarin is administered only in the first 3 years after surgery and discontinued 3 years after surgery.

Citation： HUANGHuan-lei, LIUXiao-yuan, LUCong, GUOHui-ming, XIAOXue-jun, WURuo-bin, CHENJi-mei, ZHUANGJian. Long-term Outcomes of Patients without Anticoagulation Therapy after Prosthetic Aortic Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 151-155. doi: 10.7507/1007-4848.20140047 Copy

1.	You Jh,Chan FW,Wong RS,et al.Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol,2005,59 (5):582-587.
2.	Dang MT,Hambleton J,Kayser SR.The influence of ethnicity on warfarin dosage requirement.Ann Pharmacother,2005,39 (6):1008-1012.
3.	Katircioglu SF,Yamak B,Ulus AT,et al.Aortic valve replacement with the St.Jude Medical prosthesis and fixed dose anticoagulation.J Card Surg,1997,12 (6):363-370.
4.	Rhie S,Choi J Y,Jang I S,et al.Relationship between the occurrence of Thromboembolism and INR measurement interval in low intensity anticoagulation after aortic mechanical valve replacement.Korean J Thorac Cardiovasc Surg,2011,44 (3):220-224.
5.	Torella M,Torella D,Chiodini P,et al.Lowering the Intensity of oral anticoagulant therapy in patients with bileaflet mechanical aortic valve replacement:results from the "LOWERING-IT" Trial.Am Heart J,2010,160 (1):171-178.
6.	Bonow RO,Carabello B,Chatterjee K,et al.Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the management of Patients With Valvular Heart Disease).Circulation,2008,118:e523-e661.
7.	Salem DN,O'gara PT,Christopher MC,et al.Valvular and structural heart disease:American college of chest physicians Evidence-Based clinical practice guidelines (8th Edition).Chest,2008,133 (6 Suppl):593-629.
8.	Vahanian A,Baumgartner H,Bax J,et al.Guidelines on the management of valvular heart disease:The task force on the management of valvular heart disease of the European Society of Cardiology.Eur Heart J,2007,28 (2):230-268.
9.	Zhang HB,Li JZ,Liu Y,et al.Low-intensity international normalized ratio (INR) oral anticoagulant therapy in Chinese patients with mechanical heart valve prostheses.Cell Biochem Biophys,2012,62 (1):147-151.
10.	Kuntze C,Ebels T,Eijgelaar A,et al.Rates of thromboembolism with three different mechanical heart valve prostheses:Randomized study.Lancet,1989:1 (8637):514-517.
11.	Eitz T,Schenk S,Fritzsche D,et al.International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.Ann Thorac Surg,2008,85 (3):949-955.
12.	黄焕雷,肖学钧,卢聪,等.升主动脉扩张在主动脉瓣置换术后的变化.中山大学学报:医学科学版,2008,29 (1):108-112.
13.	Pengo V,Palareti G,Cucchini U,et al.Low-intensity oral anticoagulant plus low-dose aspirin during the first six months versus standardintensity oral anticoagulant therapy after mechanical heart valve replacement:A pilot study of low-intensity warfarin and aspirin in cardiac prostheses (LIWACAP).Clin Appl Thromb Hemost,2007,13 (3):241-248.
14.	Cannegieter SC,Rosendaal FR,Wintzen AR,et al.Optimal oral anticoagulant therapy in patients with mechanical heart valves.N Engl J Med,1995,333 (1):11-17.
15.	Koertke H,Zittermann A,Tenderich G,et al.Low-dose oral anticoagulation in patients with mechanical heart valve prostheses:final report from the early self-management anticoagulation trial Ⅱ.Eur Heart J,2007,28 (20):2479-2484.
16.	Jeong SC,Kim MJ,Song CM,et al.Low-intensity oral anticoagulation versus high-intensity oral anticoagulation in patients with mechanical bileaflet prosthetic heart valves.Korean J Thorac Cardiovasc Surg,2008,41:430-438.
17.	Van Nooten GJ,Taeymans Y,Van Belleghem Y,et al.Lower anticoagulation for mechanical heart valves:experience with the ATS bileaflet valve.Heart Lung Circ,2003,12 (3):164-171.
18.	De Santo LS,Romano G,Della Corte A,et al.Mechanical aortic valve replacement in young women planning on pregnancy:maternal and fetal outcomes under low oral anticoagulation,a pilot observational study on a comprehensive pre-operative counseling protocol.J Am Coll Cardiol,2012,59 (12):1110-1115.
19.	Chen EQ.Towards the safe use of warfarin in Chinese patients:the contribution from pharmacoepidemiological studies.Chin J Pharmacoepidemiol,1997,6:134-135.
20.	Kücükaksu DS,Akgül A,Uzun A,et al.Thirty years survival without anticoagulation after aortic valve replacement with a Björk-Shiley prosthesis.J Heart Valve Dis,2001,10 (4):548-549.
21.	Williams MA,van Riet S.The On-X heart valve:mid-term results in a poorly anticoagulated population.J Heart Valve Dis,2006,15 (1):80-86.
22.	Williams MA,Crause L,Van Riet S.A comparison of mechanical valve performance in a poorly anticoagulated community.J Card Surg,2004,19 (5):410-414.
23.	Halkos ME,Puskas JD.Are all bileaflet mechanical valves equal? Curr Opin Cardiol,2009,24 (2):136-141.

1. You Jh,Chan FW,Wong RS,et al.Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol,2005,59 (5):582-587.
2. Dang MT,Hambleton J,Kayser SR.The influence of ethnicity on warfarin dosage requirement.Ann Pharmacother,2005,39 (6):1008-1012.
3. Katircioglu SF,Yamak B,Ulus AT,et al.Aortic valve replacement with the St.Jude Medical prosthesis and fixed dose anticoagulation.J Card Surg,1997,12 (6):363-370.
4. Rhie S,Choi J Y,Jang I S,et al.Relationship between the occurrence of Thromboembolism and INR measurement interval in low intensity anticoagulation after aortic mechanical valve replacement.Korean J Thorac Cardiovasc Surg,2011,44 (3):220-224.
5. Torella M,Torella D,Chiodini P,et al.Lowering the Intensity of oral anticoagulant therapy in patients with bileaflet mechanical aortic valve replacement:results from the "LOWERING-IT" Trial.Am Heart J,2010,160 (1):171-178.
6. Bonow RO,Carabello B,Chatterjee K,et al.Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the management of Patients With Valvular Heart Disease).Circulation,2008,118:e523-e661.
7. Salem DN,O'gara PT,Christopher MC,et al.Valvular and structural heart disease:American college of chest physicians Evidence-Based clinical practice guidelines (8th Edition).Chest,2008,133 (6 Suppl):593-629.
8. Vahanian A,Baumgartner H,Bax J,et al.Guidelines on the management of valvular heart disease:The task force on the management of valvular heart disease of the European Society of Cardiology.Eur Heart J,2007,28 (2):230-268.
9. Zhang HB,Li JZ,Liu Y,et al.Low-intensity international normalized ratio (INR) oral anticoagulant therapy in Chinese patients with mechanical heart valve prostheses.Cell Biochem Biophys,2012,62 (1):147-151.
10. Kuntze C,Ebels T,Eijgelaar A,et al.Rates of thromboembolism with three different mechanical heart valve prostheses:Randomized study.Lancet,1989:1 (8637):514-517.
11. Eitz T,Schenk S,Fritzsche D,et al.International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.Ann Thorac Surg,2008,85 (3):949-955.
12. 黄焕雷,肖学钧,卢聪,等.升主动脉扩张在主动脉瓣置换术后的变化.中山大学学报:医学科学版,2008,29 (1):108-112.
13. Pengo V,Palareti G,Cucchini U,et al.Low-intensity oral anticoagulant plus low-dose aspirin during the first six months versus standardintensity oral anticoagulant therapy after mechanical heart valve replacement:A pilot study of low-intensity warfarin and aspirin in cardiac prostheses (LIWACAP).Clin Appl Thromb Hemost,2007,13 (3):241-248.
14. Cannegieter SC,Rosendaal FR,Wintzen AR,et al.Optimal oral anticoagulant therapy in patients with mechanical heart valves.N Engl J Med,1995,333 (1):11-17.
15. Koertke H,Zittermann A,Tenderich G,et al.Low-dose oral anticoagulation in patients with mechanical heart valve prostheses:final report from the early self-management anticoagulation trial Ⅱ.Eur Heart J,2007,28 (20):2479-2484.
16. Jeong SC,Kim MJ,Song CM,et al.Low-intensity oral anticoagulation versus high-intensity oral anticoagulation in patients with mechanical bileaflet prosthetic heart valves.Korean J Thorac Cardiovasc Surg,2008,41:430-438.
17. Van Nooten GJ,Taeymans Y,Van Belleghem Y,et al.Lower anticoagulation for mechanical heart valves:experience with the ATS bileaflet valve.Heart Lung Circ,2003,12 (3):164-171.
18. De Santo LS,Romano G,Della Corte A,et al.Mechanical aortic valve replacement in young women planning on pregnancy:maternal and fetal outcomes under low oral anticoagulation,a pilot observational study on a comprehensive pre-operative counseling protocol.J Am Coll Cardiol,2012,59 (12):1110-1115.
19. Chen EQ.Towards the safe use of warfarin in Chinese patients:the contribution from pharmacoepidemiological studies.Chin J Pharmacoepidemiol,1997,6:134-135.
20. Kücükaksu DS,Akgül A,Uzun A,et al.Thirty years survival without anticoagulation after aortic valve replacement with a Björk-Shiley prosthesis.J Heart Valve Dis,2001,10 (4):548-549.
21. Williams MA,van Riet S.The On-X heart valve:mid-term results in a poorly anticoagulated population.J Heart Valve Dis,2006,15 (1):80-86.
22. Williams MA,Crause L,Van Riet S.A comparison of mechanical valve performance in a poorly anticoagulated community.J Card Surg,2004,19 (5):410-414.
23. Halkos ME,Puskas JD.Are all bileaflet mechanical valves equal? Curr Opin Cardiol,2009,24 (2):136-141.

Previous Article
Value of Radiofrequency Ablation in Radical Cure for Hepatocellular Carcinoma
Next Article
食管罕见巨大平滑肌瘤误诊一例

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Outcomes of Patients without Anticoagulation Therapy after Prosthetic Aortic Valve Replacement

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content