Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial(ANTIPRO). 3 years follow-up

• Published in: International journal of cardiology Vol. 413; p. 132361
• Main Authors: Dayan, Victor, Fernandez, Amparo, Loza, Gimena, Parma, Gabriel, Robaina, Ricardo, Montero, Juan, Gonzalez, Eugenia, Brusich, Daniel, Florio, Lucia
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.10.2024
• Subjects: Anticoagulation; Aortic valve replacement; Bioprosthesis; Bioprosthesis; Aortic valve replacement; Anticoagulation
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132361

Most evidence for anticoagulation in aortic bioprosthesis is centered on embolic events, bleeding and re-intervention risk. The effect of anticoagulation on hemodynamics has not been previously assessed. Our hypothesis was that patients with anticoagulation (AC) early after aortic valve replacement (AVR) with porcine bioprosthesis have better hemodynamics at 3 years of follow-up. This is a follow-up evaluation of the ANTIPRO trial. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The AC group received warfarin+aspirin and the non-AC(control) only aspirin. The primary outcome was mean gradient after 3 years of AVR and change in New York Heart Association (NYHA) class. Secondary outcomes were major and minor bleeding and embolic events. Of 140 participants in the study, 71 were assigned to the AC group and 69 to the control group. Mean age of the overall population was 72.4(SD: 7.1) years. Global euroSCORE was 7.65(SD: 5.73). At 3 years the mean gradient was similar between both groups (19.4(SD: 9.6 mmHg) and 18.6(SD: 8.2 mmHg) in the control and AC group respectively, p = 0.7). No differences in functional class at 3 years were found among groups. No differences were found among groups in the secondary outcomes. The addition of 3 months of oral anticoagulation to anti-aggregation treatment did not affect bioprosthetic hemodynamics nor functional class at years after AVR. [Display omitted] •There is scarce evidence on the hemodynamic benefit of oral anticoagulation after aortic valve replacement with a porcine bioprosthesis.•The use oral anticoagulation is not associated with improved hemodynamic outcomes at 3 years after valve replacement.•Anticoagulation after aortic valve replacement with porcine bioprosthesis is not associated with improved hemodynamic nor clinical outcomes at medium term follow-up.