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Editorials

Antithrombotic therapy after bioprosthetic aortic valve replacement

^a Division of Cardiac Surgery, Hospital de Cruces, Plaza de Cruces, 48903 Barakaldo – Bizkaia, Spain
^b Department of Cardiovascular Surgery, Hospital Clinico, Barcelona, Spain

^_* Corresponding author. Tel.: +34 946006339. (Email: ji.aramendi@terra.es).

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Aortic valve replacement with a tissue valve alone or in association with coronary artery bypass grafting is being practised more and more often in the elderly, accepting the definition of elderly for people aged 65 years or more. Despite the age, many of these patients do not have associated risk factors for thromboembolism and could benefit from initially avoiding anticoagulation after valve replacement. The need for short-term anticoagulation was based on some papers showing a high incidence of thromboembolism in the first 3 months after surgery [1]. The lack of endothelium in the leaflet tissue and the presence of rough surfaces like Dacron rings and knots justified some antithrombotic treatment for 3 months until complete ‘healing’ occurs. Heras et al. [1] estimated the risk to be about 10% but these data were obtained from retrospective studies on populations operated on more than two decades ago. Present studies show that the risk is much lower, about 2–4%. These are rough percentages, for linearized rates do not apply to short periods of time like 3 months (they exaggerate four times the true incidence). A hazard-function type of analysis is more appropriate providing there is enough number of events [2]. This makes comparison difficult. In the last 5 years, several papers studying the usefulness of antiplatelets after . . . [Full Text of this Article]