【論文摘要】Impact of Different Antithrombotic Regimens on the Outcomes of Bioprosthetic Valve Replacement in Elderly Asian Population

Ya-Wen Lu ； Po-Hsun Huang

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 112-112

https://doi.org/10.6907/SCJ.201909/SP_1(2).0091

摘要

Background/Synopsis: Lifelong antithrombotic therapy is necessary for patients underwent mechanical valve replacement. However, the optimal regimen and duration of antithrombotic agents are still controversial for patients underwent bioprosthetic valve replacement. In this retrospective cohort study, we investigated the effect of different antithrombotic strategies on the prognosis of patients underwent bioprosthetic valve replacement in the elder Asian population. Objectives/Purpose: Based on the National Health Insurance Database in Taiwan, 1227 patients elderly than 50 years-old and underwent bioprosthetic valve replacement between 2003 to 2010 were enrolled for analysis. Patients were classified according to their antithrombotic therapies within 3 months after bioprosthetic valve replacements. The occurrence of stroke, all-cause mortality, and major bleeding events within 1 year after the surgeries were recorded and analyzed. Methods/Results: The 1227 patients were stratified to three groups, including aspirin alone (19.6%), warfarin alone (60.6%), and the combined usage of aspirin and warfarin (19.9%) within 3 months after surgery. After adjusting propensity scores, the warfarin group (relative risk: 0.69, 95%CI: 0.54-0.88) and the combination group (relative risk: 0.57, 95%CI: 0.42-0.79) both had lower mortality rate compared to the aspirin alone group. Neither increasing major bleeding risk (adjusted relative risk: 0.62, 95%CI: 0.15-2.68) nor decreasing ischemic stroke risk (adjusted relative risk: 0.64, 95%CI: 0.36-1.14) was noticed in the combination group. There was no interaction between age, gender, type of surgery, or underlying diseasesto the outcomes of antithrombotic therapy. Conclusion: Comparing with aspirin alone, warfarin only or combined warfarin with aspirin therapy have a lowering one-year all-cause mortality rate without increasing the occurrence of bleeding events. Warfarin is suggested to be used for at least 3 months after bioprosthetic valve replacement in the elder Asian population.