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Erschienen in: Cardiovascular Drugs and Therapy 6/2022

10.09.2021 | Original Article

The Prognostic Impact of Anti-thrombotic Treatment Strategies After Biological Aortic Valve Replacement

verfasst von: Andreas Hammer, Felix Hofer, Niema Kazem, Lorenz Koller, Sebastian Schnaubelt, Günther Laufer, Barbara Steinlechner, Johann Wojta, Christian Hengstenberg, Alexander Niessner, Patrick Sulzgruber

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 6/2022

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Abstract

Purpose

Optimal antithrombotic therapy in patients who underwent surgical biological aortic valve replacement (AVR) represents an issue of ongoing discussion. Additionally, the prognostic impact of anti-thrombotic treatment strategies after biological AVR and real-life data on anticoagulation strategies (AC) of patients presenting with short-term postoperative atrial fibrillation (POAF) has not clearly been investigated so far. Therefore, this study aimed to investigate the impact of therapeutic AC after biological AVR on patient outcome and whether the presence of POAF affects decision making on anti-thrombotic management.

Methods

Within this prospective observational study, 200 individuals that underwent biological AVR surgery were enrolled. Participants were followed prospectively until the primary study endpoint was reached. Multivariate logistic regression analysis was performed to elucidate the effect of therapeutic AC on outcome.

Results

Overall, 106 individuals received therapeutic AC at the time of discharge. The fraction of patients presenting with POAF was balanced between individuals receiving AC and the non-AC subgroup (p = 0.617). After a median follow-up time of 1418 days, 31 (15.5%) individuals died, referring to 15 (13.9%) POAF-free patients and 16 (17.4%) with POAF. We observed a strong inverse association of therapeutic AC and cardiovascular mortality, which remained stable after adjustment for potential confounders showing a HR of 0.437 (95% CI 0.202–0.943; p = 0.035), while bleeding risk was comparable (p = 0.680).

Conclusion

Within this investigation, therapeutic AC showed a strong and independent inverse association with long-term mortality in patients that underwent biological AVR. Although POAF is associated with thromboembolic adverse events, the development of this arrhythmia did not affect decision-making of the anti-thrombotic management.
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Metadaten
Titel
The Prognostic Impact of Anti-thrombotic Treatment Strategies After Biological Aortic Valve Replacement
verfasst von
Andreas Hammer
Felix Hofer
Niema Kazem
Lorenz Koller
Sebastian Schnaubelt
Günther Laufer
Barbara Steinlechner
Johann Wojta
Christian Hengstenberg
Alexander Niessner
Patrick Sulzgruber
Publikationsdatum
10.09.2021
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 6/2022
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-021-07247-2

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