JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Paul Vaughan
Paul D. Waterworth
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vaughan, P.
Right arrow Articles by Waterworth, P. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vaughan, P.
Right arrow Articles by Waterworth, P. D.
Related Collections
Right arrow Cardiac - pharmacology
Right arrowRelated Article

J Thorac Cardiovasc Surg 2006;131:1425
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Anticoagulation after bioprosthetic aortic valve replacement

Paul Vaughan, MRCS, Ed a , Paul D. Waterworth, FRCS (CTh) b

a Department of Thoracic Surgery, Glenfield Hospital, Leicester
b Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester

To the Editor:

GoWe read with interest the letter by di Marco and associates 1 Go concerning anticoagulation after bioprosthetic aortic valve replacement. We also performed a survey of such anticoagulation practice among UK consultant cardiothoracic surgeons. 2 Go This highlights a similar disparity between the accepted guidelines and actual practice in the postoperative management of patients undergoing bioprosthetic aortic valve replacement, without comorbidities or risk factors that necessitate anticoagulation.

In our survey, only 16% of consultants (16/97) adhered to the comparable American College of Chest Physicians (ACCP) 3 Go or American College of Cardiology/American Heart Association guidelines. 4 Go The majority of consultants (51/97 [52%]) never used warfarin at all postoperatively, of whom 40 of 51 (78%) initiated antiplatelet therapy instead. The other 22% (11/51) used neither antiplatelet nor anticoagulation therapy postoperatively.

It is important to note that the ACCP guidelines recommending 3 months of anticoagulation postoperatively are termed a "Grade 2C Recommendation." This means that the evidence for the recommendation came from observational studies or case series. As such, the ACCP accepts that the evidence is of low quality, and that there is uncertainty in the estimates of benefits, risks, and burden. The ACCP is aware this is a very weak recommendation, and other alternatives may be equally reasonable. 5 Go

Given that so few surgeons seem to be following these guidelines, we await the updated European Society of Cardiology recommendations with anticipation.

Perhaps the prospective randomized clinical trial being undertaken by di Marco and associates 1 Go will provide stronger evidence and clarify a controversial area in the management of bioprosthetic heart valve replacement.


See related editorial on page 1223.

 


   References
Top
 References
 

  1. di Marco F, Meneghetti G, Gerosa G. Early anticoagulation after aortic valve replacement with bioprostheses. time to abandon it?. J Thorac Cardiovasc Surg 2005;130:1482-1483.[Free Full Text]
  2. Vaughan P, Waterworth P. An audit of anticoagulation practice among UK cardiothoracic consultant surgeons following valve replacement/repair. J Heart Valve Dis 2005;14:576-582.[Medline]
  3. Stein PD, Alpert JS, Bussey HI, Dalen JE, Turpie AGG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 2001;119:220-227.
  4. Bonow RO, Carabello B, de Leon Jr AC, Edmunds Jr LH, Fedderly BJ, Freed, MD, et al. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation. 1998;98:1949-1984.[Free Full Text]
  5. Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines. Report from an American College of Chest Physicians' Task Force. Chest 2006;129:174-181.[Medline]

Related Article

Early antithrombotic therapy after aortic valve replacement with tissue valves: When the practice diverges from the guidelines
Francesca di Marco, Massimo Giordan, and Gino Gerosa
J. Thorac. Cardiovasc. Surg. 2006 131: 1223. [Extract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Paul Vaughan
Paul D. Waterworth
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vaughan, P.
Right arrow Articles by Waterworth, P. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vaughan, P.
Right arrow Articles by Waterworth, P. D.
Related Collections
Right arrow Cardiac - pharmacology
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS