Impact of aspirin use in the incidence of thromboembolic events after bioprosthesis replacement in patients with rheumatic disease

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 28; no. 3; pp. 347 - 352
• Main Authors: Durães, André Rodrigues, Durães, Milena Andrade Oliveira, Correia, Luis Claudio, Fernandes, André Mauricio Souza, Aras Junior, Roque
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01.07.2013
• Subjects: Acidente vascular cerebral; Adult; Aspirin - therapeutic use; Aspirina; Bioprosthesis - adverse effects; Bioprótese; Brain Ischemia - epidemiology; Brain Ischemia - prevention & control; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiology; Cardiopatia reumática; Disease-Free Survival; Female; Heart surgery; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Postoperative Care; Postoperative Complications; Prospective Studies; Rheumatic Heart Disease - surgery; Risk Factors; Stroke - prevention & control; SURGERY; Thromboembolism - epidemiology; Thromboembolism - prevention & control; Time Factors; Treatment Outcome; Bioprótese; Aspirina; Aspirin; Stroke; Cardiopatia reumática; Bioprosthesis; Rheumatic heart disease; Acidente vascular cerebral
• ISSN: 0102-7638; 1678-9741; 1678-9741
• DOI: 10.5935/1678-9741.20130054

There is still much debate regarding the kind of antithrombotic therapy in the immediate postoperative period of bioprosthesis replacement (first three months). Thus, the authors consider relevant to determine the contemporary incidence of thromboembolic events in rheumatic patients early after implantation of aortic and mitral bioprosthesis replacement (first 90 days in the post-operative period) and perform a comparison between isolated Aspirin uses versus no-antiplatelet therapy, in this same context. Between the period of January 2010 to July 2012, all consecutive rheumatic patients, with basal sinus rhythm, who performed mitral and aortic valve replacement with bioprosthesis (pericardial bovine), were included in this prospective cohort study, 184 patients in total. The primary endpoint evaluated were the rate of embolic events. In the first 30 days, there were three cerebral ischemic events among patients treated in Aspirin group (5.2%) compared with two events in patients without Aspirin therapy (1.7%), HR = 3.18; 95% CI 0.5 to 19.6; P=0.33. Between 31 and 90 days postoperatively, no patient had a primary outcome. The embolism-free survival, bleeding events and the overall survival were not statistically significant between the aspirin and no-antiplatelet groups. In conclusion, in this prospective cohort of rheumatic patients, we found a low and very rare incidence rate of embolic events during the first 90 days postoperative period in mitral and isolated aortic position, respectively. The use of aspirin did not significantly reduce the rate of thromboembolism.