Is Long-term Warfarin Therapy Necessary in Chinese Patients with Atrial Fibrillation after Bioprosthetic Mitral Valve Replacement and Left Atrial Appendage Obliteration?

Authors

  • Lin Zhang Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing
  • Shengli Jiang Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing
  • Chonglei Ren Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing
  • Changqing Gao Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing

DOI:

https://doi.org/10.1532/hsf.1219

Abstract

Background: Long-term warfarin therapy has been used to decrease thromboembolic events in patients with atrial fibrillation (AF) following bioprosthetic mitral valve replacement (BMVR) and left atrial appendage obliteration (LAAO). A retrospective study was conducted to investigate the efficacy of long-term warfarin or aspirin therapy in patients with AF after BMVR and LAAO.
Methods: A total of 215 patients with persistent AF were given anticoagulation therapy with warfarin for the first
3 months after BMVR and LAAO, continuing warfarin or aspirin therapy according to the surgeon’s preference. A yearly follow-up with patients was performed by telephone or mail for postoperative condition, cerebrovascular, and bleeding events.
Results: Seven patients died in the first 3 months after surgery, including 6 patients from heart failure and 1 patient from sudden death. The remaining 208 patients were divided into two groups: warfarin group (n = 84 patients) and aspirin group (n = 124). The patients in the warfarin group were older than those in the aspirin group and had a lower postoperative left ventricular ejection fraction. Other baseline and operative characteristics were similar. The two groups had similar incidence of thromboembolic events (9.5% versus 8.9%, P = .873) and bleeding events(7.1% versus 3.2%,
P = .207). Each group had one intracranial hemorrhage. Eleven patients expired within three months after surgery, 4(4.8%) in the warfarin group and 10(8.1%)in the aspirin group (P = .411 by Fisher exact test). Cumulative survival was not significantly different in the two groups by Kaplan-Meier analysis (P = .55, log-rank test).
Conclusion: At the current time in China, long-term warfarin or aspirin therapy may have no significantly different impact on long-term prognosis after 3 months anticoagulation with warfarin in patients with AF undergoing BMVR and LAAO.

Published

2015-04-06

How to Cite

Zhang, L., Jiang, S., Ren, C., & Gao, C. (2015). Is Long-term Warfarin Therapy Necessary in Chinese Patients with Atrial Fibrillation after Bioprosthetic Mitral Valve Replacement and Left Atrial Appendage Obliteration?. The Heart Surgery Forum, 18(1), E011-E016. https://doi.org/10.1532/hsf.1219

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