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J Thorac Cardiovasc Surg 2006;131:1223
© 2006 The American Association for Thoracic Surgery

Editorial

Early antithrombotic therapy after aortic valve replacement with tissue valves: When the practice diverges from the guidelines

^a Department of Cardiological, Thoracic, and Vascular Sciences, Division of Cardiac Surgery, Padua University Medical School, Padova, Italy
^b Interventional Cardiology-Cardiology Division, Ospedale Civile Rovigo, Rovigo, Italy.

Received for publication December 20, 2005; accepted for publication January 24, 2006.

^_* Address for reprints: Francesca di Marco, MD, Via Giustiniani 2, 35100 Padova, Italy. (Email: maxgiordan@yahoo.it).

The first 300 words of the full text of this article appear below.

The American College of Cardiology (ACC) and American Heart Association (AHA) practice guidelines (dating back to 1998) propose early anticoagulation with warfarin as a class I recommendation in patients with biologic prosthetic heart valves, with a target international normalized ratio (INR) of 2.5 to 3.5, during the first 3 months from the implant. The guidelines do not make any distinction among type of prosthesis (biologic or mechanical) or site of implant. ^E1

The first 3 postoperative months are classically considered a high-risk time interval for thromboemboli formation, as long as the process of endothelialization of sewing ring and sutures reaches completion. ^E2 Biologic valves have been recognized to be at lower risk when compared with mechanical valves ^E3 ; among them, aortic bioprostheses show inferior thrombogenicity than mitral bioprostheses. ^E4

Last year, the CTSNet Valve Technology Center released the results of its study, ^E5 which focused on the early antithrombotic regimen adopted by CTSNet Surgeons members, after aortic tissue valve replacement. The study intended to establish the level of awareness of the ACC/AHA guidelines among the 726 participating surgeons and the adherence to the guidelines in their daily practice. In each country (mainly the United States and Europe), the percentage of respondents acquainted with or unaware of the guidelines were equally distributed, with an overall prevalence of awareness (79% vs 21%).

Three main issues emerged from the study:

1 More than 60% of surgeons are convinced that oral anticoagulation therapy administration prolongs hospital stay of approximately 2 to 3 days.

2 More than 60% believe that antiplatelet therapy alone represents a valuable alternative, in absence of comorbidities, granting patients safety and reducing overall stay and cost of care; they no longer consider warfarin to be the gold standard of early antithrombotic therapy for biologic valves.

3 Approximately 50% of surgeons adopt antiplatelet therapy in their . . . [Full Text of this Article]

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