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Eur J Cardiothorac Surg 2007;31:573-577. doi:10.1016/j.ejcts.2007.02.002
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Reviews

Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue

^a Department of Cardiac Surgery, University of Parma, Italy
^b Department of Thoracic and Cardiovascular Surgery, University Hospital Ponchaillou, Rennes, France

Received 3 November 2006; received in revised form 26 January 2007; accepted 2 February 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Hospital Clinic, C. Villaroel 170, 08036, Barcelona, Spain. Tel.: +39 03495928935/+34687203754; fax: +39 04932275749. (Email: colli.andrea{at}libero.it).

Improvements in the performance and longevity of biological valve prostheses have steadily increased their rates of implantation in recent years. Aortic bioprostheses, which are commonly used in the elderly or when the risks of anticoagulating are high, have generally been associated with low rates of long-term complications. Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described, a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement has not been developed. There are also important differences between the international guidelines published. This review examines the clinical evidence concerning the use of vitamin K antagonist and antiplatelet therapy in the early management of the antithrombotic complications after bioprosthetic aortic valve replacement.

Key Words: Bioprosthesis • Surgery • Anticoagulation • Acetyl salicylic acid • Antiplatelet therapy

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