Anticoagulation for Patients with Large Left Atrium after Mitral Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONGHao ,  ZHANGKai-lun , DONGNian-guo , SUNZong-quan , XIAOShi-liang , DUXin-ling , JIANGXiong-gang , XIAJia-hong , HUZhi-wei , SUWei , LIUJin-ping , SUNTu-cheng , SHIJia-wei

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, P. R. China;

Corresponding author：

ZHANGKai-lun, Email: prozkl@163.com

Keywords：

Large left atrium; Mitral valve replacement; Anticoagulation therapy; Aspirin

DOI：

10.7507/1007-4848.20140049

Video：

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Objective To compare clinical results of different anticoagulation methods for patients with large left atrium in the early period after mitral valve replacement (MVR) in order to optimize anticoagulation therapy for them. Methods A total of 144 patients with large left atrium who underwent MVR in Union Hospital of Tongji Medical College from January 2012 to September 2013 were included in this study. There were 76 male and 68 female patients with their age of 36-60 (47.4±7.0) years. All the patients were divided into 2 groups according to different anticoagulation methods after MVR. Group A patients received warfarin anticoagulation since the 2nd postoperative day. Group B patients received warfarin and aspirin (0.1 g daily) since the 2nd postoperative day. Morbidity and mortality during follow-up were compared between the 2 groups. Results International normalized ratio (INR) was 2.03±0.11 in group A and 2.01±0.11 in group B,and there was no statistical difference between the 2 groups (t=0.804,P>0.05). Twenty patients (13.9%) had hemorrhagic complications. There was no statistical difference in INR between patients with hemorrhagic complications in group A and B (t=0.496,P>0. 05) and there was no statistical difference in hemorrhagic rate between group A and B(P>0. 05). There was no thromboembolic complication in group B,and 9 patients (6.3%) in group A had thromboembolic complications. Three patients (2%) died of intracranial hemorrhage in group A during follow-up. Two patients died in group B,including 1 patient with recurrent pericardial effusion and pericardial tamponade who died 60 days after surgery,and another patient who died of unknown reason during follow-up. Conclusion For MVR patients with large left atrium,anticoagulation with warfarin and aspirin can significantly decrease the incidence of thromboembolic complications but does not increase the incidence of hemorrhagic complications.

Citation： HONGHao, ZHANGKai-lun, DONGNian-guo, SUNZong-quan, XIAOShi-liang, DUXin-ling, JIANGXiong-gang, XIAJia-hong, HUZhi-wei, SUWei, LIUJin-ping, SUNTu-cheng, SHIJia-wei. Anticoagulation for Patients with Large Left Atrium after Mitral Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 156-159. doi: 10.7507/1007-4848.20140049 Copy

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13.	刁明强,董力,江虹,等.心脏机械瓣膜置换术后早期抗凝的方法分析.中国胸心血管外科临床杂志,2006,13 (1):1013.
14.	Uesuka Y,Hosoda S,Kasanuki H,et al.Optimal therapeutic range for oral ant icoagulantsin Japanese patient s w ith prosthetic heart valves:a preliminary report from a single inst itut ion using conversion f rom thrombot est to PT-INR.Heart Vessels,2000,15 (3):124-128.
15.	Chenhsu RY,Chiang SC,Chou MH,et al.Long-term treatment with warfarin in Chinese population.Ann Pharmacother,2000,34 (12):13951401.
16.	De Cecco CN,Buffa V,David V,et al.Novel approaches for the surgical treatment of atrial fibrillation:time for a guideline revision? Vasc Health Risk Manag,2010,6:439-447.
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19.	Ad N,Henry L,Hunt S.Current role for surgery in treatment of lone atrial fibrillation.Semin Thorac Cardiovasc Surg,2012,24 (1):42-50.
20.	Nasso G,Bonifazi R,Del Prete A,et al.Long-term results of ablation for isolated atrial fibrillation through a right minithoracotomy:toward a rational revision of treatment protocols.J Thorac Cardiovasc Surg,2011,142 (2):e41-46.

1. Stambler BS.A new era of stroke prevention in atrial fibrillation:comparing a new generation of oral anticoagulants withwarfarin.Int Arch Med,2013,31,6 (1):46.
2. Snipelisky D,Kusumoto F.Current strategies to minimize the bleeding risk of warfarin.J Blood Med,2013,4:89-99.
3. Gomes T,Mamdani MM,Holbrook AM,et al.Rates of hemorrhage during warfarin therapy for atrial fibrillation.CMAJ,2013,185 (2):E121-7.
4. Edmunds LH Jr,Clark RE,Cohn LH,et al.Guidelines f or report ing morbidit y and mort ality after cardiac valvular operatios.Ann thorac Surg,1996,62 (3):932-935.
5. Hirsh J,Dalen JE,Guytt G.The sixth (2000) ACCP guidelines for antithrombolic therapy f or prevent ion and t reatment of thrombosis.Chest,2001,119 (Suppl 1):1-2.
6. Eikelboom JW,Connolly SJ,Brueckmann M,et al.Dabigatran versus warfarin in patients with mechanical heart valves.N Engl J Med,2013,369 (13):1206-1214.
7. Kaneko T,Aranki SF.Anticoagulation for prosthetic valves.Thrombosis,2013,2013:346752.
8. Whitlock RP,Sun JC,Fremes SE,et al.Antithrombotic and thrombolytic therapy for valvular disease:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,2012,141 (2 Suppl):576-600.
9. Michota F.Transitions of care in anticoagulated patients.J Multidiscip Healthc,2013,6:215-228.
10. Monagle P,Chan AK,Goldenberg NA,et al.Antithrombotic therapy in neonates and children:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians EvidenceBased Clinical Practice Guidelines.American College of Chest Physicians.Chest,2012,141 (2 Suppl):e737S-801S.
11. You JJ,Singer DE,Howard PA,et al.Antithrombotic therapy for atrial fibrillation:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.American College of Chest Physicians.Chest,2012,141 (2 Suppl):e531S-75S.
12. Holbrook A,Schulman S,Witt DM,et al.Evidence-based management of anticoagulant therapy:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.American College of Chest Physicians.Chest,2012,141 (2 Suppl):e152S-84S.
13. 刁明强,董力,江虹,等.心脏机械瓣膜置换术后早期抗凝的方法分析.中国胸心血管外科临床杂志,2006,13 (1):1013.
14. Uesuka Y,Hosoda S,Kasanuki H,et al.Optimal therapeutic range for oral ant icoagulantsin Japanese patient s w ith prosthetic heart valves:a preliminary report from a single inst itut ion using conversion f rom thrombot est to PT-INR.Heart Vessels,2000,15 (3):124-128.
15. Chenhsu RY,Chiang SC,Chou MH,et al.Long-term treatment with warfarin in Chinese population.Ann Pharmacother,2000,34 (12):13951401.
16. De Cecco CN,Buffa V,David V,et al.Novel approaches for the surgical treatment of atrial fibrillation:time for a guideline revision? Vasc Health Risk Manag,2010,6:439-447.
17. Speziale G,Bonifazi R,Nasso G,et al.Minimally invasive radiofrequency ablation of lone atrial fibrillation by monolateral right minithoracotomy:operative and early follow-up results.Ann Thorac Surg,2010,90 (1):161-167.
18. Mack MJ.Current results of minimally invasive surgical ablation for isolated atrial fibrillation.Heart Rhythm,2009,6 (12 Suppl):S46-S49.
19. Ad N,Henry L,Hunt S.Current role for surgery in treatment of lone atrial fibrillation.Semin Thorac Cardiovasc Surg,2012,24 (1):42-50.
20. Nasso G,Bonifazi R,Del Prete A,et al.Long-term results of ablation for isolated atrial fibrillation through a right minithoracotomy:toward a rational revision of treatment protocols.J Thorac Cardiovasc Surg,2011,142 (2):e41-46.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Anticoagulation for Patients with Large Left Atrium after Mitral Valve Replacement

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