1. Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair
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Domenico Paparella, Michele Di Mauro, Keren Bitton Worms, Gil Bolotin, Claudio Russo, Salvatore Trunfio, Roberto Scrofani, Carlo Antona, Guglielmo Actis Dato, Riccardo Casabona, Andrea Colli, Gino Gerosa, Attilio Renzulli, Filiberto Serraino, Giuseppe Scrascia, Salvatore Zaccaria, Michele De Bonis, Maurizio Taramasso, Luis Delgado, Francesco Tritto, Joseph Marmo, Alessandro Parolari, Veronika Myaseodova, Emmanuel Villa, Giovanni Troise, Francesco Nicolini, Tiziano Gherli, Richard Whitlock, Manuela Conte, Fabio Barili, Sandro Gelsomino, Roberto Lorusso, Edoardo Sciatti, Daniele Marinelli, Gabriele Di Giammarco, Antonio Maria Calafiore, Azmat Sheikh, Juan Jaime Alfonso, Mattia Glauber, Antonio Miceli, Crescenzia Rotunno, Ziv Beckerman, Luigi Martinelli, Marco Lanfranconi, Davide Foresti, Egidio Varone, Giuseppe Punta, Ottavio Alfieri, Elisabetta Lapenna, Gennaro Ismeno, Achille Pulcino, Francesco Alamanni, Margherita Dalla Tomba, Giuseppe Coletti, Enrico Vizzardi, Antonio Lio, Marco Solinas, Massimiliano Foschi, Nutrition, obésité et risque thrombotique ( NORT ), Institut National de la Recherche Agronomique ( INRA ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de Recherche en Cancérologie de Lyon ( CRCL ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Hospices Civils de Lyon ( HCL ), RS: CARIM - R2.12 - Surgical intervention, CTC, MUMC+: MA Med Staf Spec CTC (9), Nutrition, obésité et risque thrombotique (NORT), Aix Marseille Université (AMU)-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL), Centre de Recherche en Cancérologie de Lyon (CRCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Paparella, D, Di Mauro, M, Bitton Worms, K, Bolotin, G, Russo, C, Trunfio, S, Scrofani, R, Antona, C, Actis Dato, G, Casabona, R, Colli, A, Gerosa, G, Renzulli, A, Serraino, F, Scrascia, G, Zaccaria, S, De Bonis, M, Taramasso, M, Delgado, L, Tritto, F, Marmo, J, Parolari, A, Myaseodova, V, Villa, E, Troise, G, Nicolini, F, Gherli, T, Whitlock, R, Conte, M, Barili, F, Gelsomino, S, Lorusso, R, Sciatti, E, Marinelli, D, Di Giammarco, G, Calafiore, Am, Sheikh, A, Alfonso, Jj, Glauber, M, Miceli, A, and Giroc, Investigators
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Male ,Vitamin K ,Databases, Factual ,analysis ,medicine.medical_treatment ,Administration, Oral ,030204 cardiovascular system & hematology ,antiplatelet ,[ SDV.CAN ] Life Sciences [q-bio]/Cancer ,Cohort Studies ,surgery ,Postoperative Complications ,0302 clinical medicine ,Antithrombotic ,anticoagulation ,Ultrasonography ,Heart Valve Prosthesis Implantation ,Incidence ,Age Factors ,Mitral Valve Insufficiency ,Atrial fibrillation ,Middle Aged ,Vitamin K antagonist ,stroke ,3. Good health ,Survival Rate ,Treatment Outcome ,Italy ,Platelet aggregation inhibitor ,Female ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,Cohort study ,Pulmonary and Respiratory Medicine ,Adult ,Risk ,medicine.medical_specialty ,Canada ,Patients ,complications ,medicine.drug_class ,Injections, Subcutaneous ,Hemorrhage ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Risk Assessment ,Statistics, Nonparametric ,methods ,03 medical and health sciences ,mitral valve repair ,Sex Factors ,Predictive Value of Tests ,Thromboembolism ,medicine ,Humans ,bleeding ,Surgery ,Retrospective Studies ,Aged ,Mitral valve repair ,therapy ,business.industry ,Anticoagulants ,Retrospective cohort study ,medicine.disease ,mortality ,ROC Curve ,030228 respiratory system ,Multivariate Analysis ,business ,Platelet Aggregation Inhibitors ,Follow-Up Studies - Abstract
International audience; OBJECTIVE: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome. METHODS: Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 +/- 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286). RESULTS: No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P = .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P = .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P = .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months. CONCLUSIONS: Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial
- Published
- 2016
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