High risk of thromboemboli early after bioprosthetic cardiac valve replacement

Magda Heras, James H. Chesebro, Valentin Fuster, William J. Penny, Diane E. Grill, Kent R Bailey, Gordon K. Danielson, Thomas A. Orszulak, James R. Pluth, Francisco J. Puga, Hartzell V Schaff, Jeffrey J. Larsonkeller

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

Objectives.: We studied the rate of thromboembolism in patients undergoing bioprosthetic replacement of the aortic or mitral valve, or both, at serial intervals after operation and the effects of anticoagulant or antiplatelet treatment and risk factors. Background.: Thromboembolism appears to occur early after operation, but the incidence, timing and risk factors for thromboembolism and the role, timing, adequacy, effectiveness, duration and risk of anticoagulation and antiplatelet agents are uncertain. Methods.: The rate of thromboembolism was studied at three time intervals after operation (1 to 10, 11 to 90 and >90 days) in 816 patients who underwent bioprosthetic replacement of the aortic or mitral valve, or both, at the Mayo Clinic from January 1975 to December 1982. The effect of antithrombotic therapy (warfarin, aspirin or dipyridamole, alone or in combination) was evaluated. Results.: Median follow-up of surviving patients was 8.6 years. The rate of thromboembolism (%/year) decreased significantly (p < 0.01) at each time interval after operation (1 to 10, 11 to 90 and >90 days) for mitral valve replacement (55%, 10% and 2.4%/year, respectively) and over the first time interval for aortic valve replacement (41%,3.6% and 1.9%/year, respectively). During the first 10 days, 52% to 70% of prothrombin time ratios were low (<1.5 × control). Patients with mitral valve replacement who received anticoagulation had a lower rate of thromboembolism for the entire follow-up period (2.5%/year with vs. 3.9%/year without anticoagulation, p = 0.05). Of 112 patients with a first thromboembolic episode, permanent disability occurred in 38% and death in 4%. Risk factors for emboli were lack of anticoagulation, mitral valve location, history of thromboembolism and increasing age. Only 10% of aortic, 44% of mitral and 17% of double valve recipients had anticoagulation at the time of an event. Patients with bleeding episodes (2.3%/year) were older and usually underwent anticoagulation. Blood transfusions were required in 60 of 111 patients (1.2%/year), and 13 patients (0.3%/year) died. Conclusions.: Thromboembolic risk was especially high for aortic and mitral valve replacement for 90 days after operation, and overall was increased with lack of anticoagulation, mitral valve location, previous thromboembolism and increasing age. Anticoagulation reduced thromboemboli and appears to be indicated in all patients as early as possible for 3 months and thereafter in those with risk factors, but needs prospective testing.

Original languageEnglish (US)
Pages (from-to)1111-1119
Number of pages9
JournalJournal of the American College of Cardiology
Volume25
Issue number5
DOIs
StatePublished - 1995

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Heart Valves
Thromboembolism
Mitral Valve
Aortic Valve
Anticoagulants
Dipyridamole
Platelet Aggregation Inhibitors
Prothrombin Time
Warfarin
Embolism
Blood Transfusion
Aspirin
Hemorrhage
Incidence
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Heras, M., Chesebro, J. H., Fuster, V., Penny, W. J., Grill, D. E., Bailey, K. R., ... Larsonkeller, J. J. (1995). High risk of thromboemboli early after bioprosthetic cardiac valve replacement. Journal of the American College of Cardiology, 25(5), 1111-1119. https://doi.org/10.1016/0735-1097(94)00563-6

High risk of thromboemboli early after bioprosthetic cardiac valve replacement. / Heras, Magda; Chesebro, James H.; Fuster, Valentin; Penny, William J.; Grill, Diane E.; Bailey, Kent R; Danielson, Gordon K.; Orszulak, Thomas A.; Pluth, James R.; Puga, Francisco J.; Schaff, Hartzell V; Larsonkeller, Jeffrey J.

In: Journal of the American College of Cardiology, Vol. 25, No. 5, 1995, p. 1111-1119.

Research output: Contribution to journalArticle

Heras, M, Chesebro, JH, Fuster, V, Penny, WJ, Grill, DE, Bailey, KR, Danielson, GK, Orszulak, TA, Pluth, JR, Puga, FJ, Schaff, HV & Larsonkeller, JJ 1995, 'High risk of thromboemboli early after bioprosthetic cardiac valve replacement', Journal of the American College of Cardiology, vol. 25, no. 5, pp. 1111-1119. https://doi.org/10.1016/0735-1097(94)00563-6
Heras, Magda ; Chesebro, James H. ; Fuster, Valentin ; Penny, William J. ; Grill, Diane E. ; Bailey, Kent R ; Danielson, Gordon K. ; Orszulak, Thomas A. ; Pluth, James R. ; Puga, Francisco J. ; Schaff, Hartzell V ; Larsonkeller, Jeffrey J. / High risk of thromboemboli early after bioprosthetic cardiac valve replacement. In: Journal of the American College of Cardiology. 1995 ; Vol. 25, No. 5. pp. 1111-1119.
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abstract = "Objectives.: We studied the rate of thromboembolism in patients undergoing bioprosthetic replacement of the aortic or mitral valve, or both, at serial intervals after operation and the effects of anticoagulant or antiplatelet treatment and risk factors. Background.: Thromboembolism appears to occur early after operation, but the incidence, timing and risk factors for thromboembolism and the role, timing, adequacy, effectiveness, duration and risk of anticoagulation and antiplatelet agents are uncertain. Methods.: The rate of thromboembolism was studied at three time intervals after operation (1 to 10, 11 to 90 and >90 days) in 816 patients who underwent bioprosthetic replacement of the aortic or mitral valve, or both, at the Mayo Clinic from January 1975 to December 1982. The effect of antithrombotic therapy (warfarin, aspirin or dipyridamole, alone or in combination) was evaluated. Results.: Median follow-up of surviving patients was 8.6 years. The rate of thromboembolism ({\%}/year) decreased significantly (p < 0.01) at each time interval after operation (1 to 10, 11 to 90 and >90 days) for mitral valve replacement (55{\%}, 10{\%} and 2.4{\%}/year, respectively) and over the first time interval for aortic valve replacement (41{\%},3.6{\%} and 1.9{\%}/year, respectively). During the first 10 days, 52{\%} to 70{\%} of prothrombin time ratios were low (<1.5 × control). Patients with mitral valve replacement who received anticoagulation had a lower rate of thromboembolism for the entire follow-up period (2.5{\%}/year with vs. 3.9{\%}/year without anticoagulation, p = 0.05). Of 112 patients with a first thromboembolic episode, permanent disability occurred in 38{\%} and death in 4{\%}. Risk factors for emboli were lack of anticoagulation, mitral valve location, history of thromboembolism and increasing age. Only 10{\%} of aortic, 44{\%} of mitral and 17{\%} of double valve recipients had anticoagulation at the time of an event. Patients with bleeding episodes (2.3{\%}/year) were older and usually underwent anticoagulation. Blood transfusions were required in 60 of 111 patients (1.2{\%}/year), and 13 patients (0.3{\%}/year) died. Conclusions.: Thromboembolic risk was especially high for aortic and mitral valve replacement for 90 days after operation, and overall was increased with lack of anticoagulation, mitral valve location, previous thromboembolism and increasing age. Anticoagulation reduced thromboemboli and appears to be indicated in all patients as early as possible for 3 months and thereafter in those with risk factors, but needs prospective testing.",
author = "Magda Heras and Chesebro, {James H.} and Valentin Fuster and Penny, {William J.} and Grill, {Diane E.} and Bailey, {Kent R} and Danielson, {Gordon K.} and Orszulak, {Thomas A.} and Pluth, {James R.} and Puga, {Francisco J.} and Schaff, {Hartzell V} and Larsonkeller, {Jeffrey J.}",
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T1 - High risk of thromboemboli early after bioprosthetic cardiac valve replacement

AU - Heras, Magda

AU - Chesebro, James H.

AU - Fuster, Valentin

AU - Penny, William J.

AU - Grill, Diane E.

AU - Bailey, Kent R

AU - Danielson, Gordon K.

AU - Orszulak, Thomas A.

AU - Pluth, James R.

AU - Puga, Francisco J.

AU - Schaff, Hartzell V

AU - Larsonkeller, Jeffrey J.

PY - 1995

Y1 - 1995

N2 - Objectives.: We studied the rate of thromboembolism in patients undergoing bioprosthetic replacement of the aortic or mitral valve, or both, at serial intervals after operation and the effects of anticoagulant or antiplatelet treatment and risk factors. Background.: Thromboembolism appears to occur early after operation, but the incidence, timing and risk factors for thromboembolism and the role, timing, adequacy, effectiveness, duration and risk of anticoagulation and antiplatelet agents are uncertain. Methods.: The rate of thromboembolism was studied at three time intervals after operation (1 to 10, 11 to 90 and >90 days) in 816 patients who underwent bioprosthetic replacement of the aortic or mitral valve, or both, at the Mayo Clinic from January 1975 to December 1982. The effect of antithrombotic therapy (warfarin, aspirin or dipyridamole, alone or in combination) was evaluated. Results.: Median follow-up of surviving patients was 8.6 years. The rate of thromboembolism (%/year) decreased significantly (p < 0.01) at each time interval after operation (1 to 10, 11 to 90 and >90 days) for mitral valve replacement (55%, 10% and 2.4%/year, respectively) and over the first time interval for aortic valve replacement (41%,3.6% and 1.9%/year, respectively). During the first 10 days, 52% to 70% of prothrombin time ratios were low (<1.5 × control). Patients with mitral valve replacement who received anticoagulation had a lower rate of thromboembolism for the entire follow-up period (2.5%/year with vs. 3.9%/year without anticoagulation, p = 0.05). Of 112 patients with a first thromboembolic episode, permanent disability occurred in 38% and death in 4%. Risk factors for emboli were lack of anticoagulation, mitral valve location, history of thromboembolism and increasing age. Only 10% of aortic, 44% of mitral and 17% of double valve recipients had anticoagulation at the time of an event. Patients with bleeding episodes (2.3%/year) were older and usually underwent anticoagulation. Blood transfusions were required in 60 of 111 patients (1.2%/year), and 13 patients (0.3%/year) died. Conclusions.: Thromboembolic risk was especially high for aortic and mitral valve replacement for 90 days after operation, and overall was increased with lack of anticoagulation, mitral valve location, previous thromboembolism and increasing age. Anticoagulation reduced thromboemboli and appears to be indicated in all patients as early as possible for 3 months and thereafter in those with risk factors, but needs prospective testing.

AB - Objectives.: We studied the rate of thromboembolism in patients undergoing bioprosthetic replacement of the aortic or mitral valve, or both, at serial intervals after operation and the effects of anticoagulant or antiplatelet treatment and risk factors. Background.: Thromboembolism appears to occur early after operation, but the incidence, timing and risk factors for thromboembolism and the role, timing, adequacy, effectiveness, duration and risk of anticoagulation and antiplatelet agents are uncertain. Methods.: The rate of thromboembolism was studied at three time intervals after operation (1 to 10, 11 to 90 and >90 days) in 816 patients who underwent bioprosthetic replacement of the aortic or mitral valve, or both, at the Mayo Clinic from January 1975 to December 1982. The effect of antithrombotic therapy (warfarin, aspirin or dipyridamole, alone or in combination) was evaluated. Results.: Median follow-up of surviving patients was 8.6 years. The rate of thromboembolism (%/year) decreased significantly (p < 0.01) at each time interval after operation (1 to 10, 11 to 90 and >90 days) for mitral valve replacement (55%, 10% and 2.4%/year, respectively) and over the first time interval for aortic valve replacement (41%,3.6% and 1.9%/year, respectively). During the first 10 days, 52% to 70% of prothrombin time ratios were low (<1.5 × control). Patients with mitral valve replacement who received anticoagulation had a lower rate of thromboembolism for the entire follow-up period (2.5%/year with vs. 3.9%/year without anticoagulation, p = 0.05). Of 112 patients with a first thromboembolic episode, permanent disability occurred in 38% and death in 4%. Risk factors for emboli were lack of anticoagulation, mitral valve location, history of thromboembolism and increasing age. Only 10% of aortic, 44% of mitral and 17% of double valve recipients had anticoagulation at the time of an event. Patients with bleeding episodes (2.3%/year) were older and usually underwent anticoagulation. Blood transfusions were required in 60 of 111 patients (1.2%/year), and 13 patients (0.3%/year) died. Conclusions.: Thromboembolic risk was especially high for aortic and mitral valve replacement for 90 days after operation, and overall was increased with lack of anticoagulation, mitral valve location, previous thromboembolism and increasing age. Anticoagulation reduced thromboemboli and appears to be indicated in all patients as early as possible for 3 months and thereafter in those with risk factors, but needs prospective testing.

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