COMPARISON OF ANTICOAGULATION REGIMENS AFTER CARPENTIER-EDWARDS AORTIC OR MITRAL-VALVE REPLACEMENT

Background To identify the optimal use of anticoagulants after Carpent ier-Edwards valve replacement, a retrospective study of all patients u ndergoing Carpentier-Edwards aortic (N=378) or mitral (N=370) valve re placement was done. Methods and Results At the time of hospital discha rge, 103 patients were managed with warfarin, 509 with aspirin alone, and 136 with no anticoagulation or antiplatelet therapy. Over the firs t 90 days after aortic or mitral valve replacement, the linearized rat e of hemorrhage was greater for warfarin than for aspirin or no therap y (16.7+/-7.6%, 3.4+/-1.7%, and 3.1+/-3.1% per patient-year, respectiv ely; P=.03). After aortic valve replacement,' aspirin provided a low r ate of thromboembolism (0.8+/-0.2% per patient-year), not significantl y different from warfarin or no treatment (2.9+/-1.6% and 1.5+/-0.6% p er patient-year) (P=.07). After mitral valve replacement, no single tr eatment was most advantageous because the rate of hemorrhage over the first 90 days for warfarin was equivalent to the 90-day rate of thromb oembolism with aspirin or no therapy. Conclusions Anticoagulation afte r Carpentier-Edwards mitral valve replacement may be best guided by in dividual patient characteristics. Within the limits of a retrospective analysis, these data support the routine use of aspirin alone after C arpentier-Edwards aortic valve replacement, both in the first 90 days and long-term.