Purpose

Optimal antithrombotic therapy in patients who underwent surgical biological aortic valve replacement (AVR) represents an issue of ongoing discussion. Additionally, the prognostic impact of anti-thrombotic treatment strategies after biological AVR and real-life data on anticoagulation strategies (AC) of patients presenting with short-term postoperative atrial fibrillation (POAF) has not clearly been investigated so far. Therefore, this study aimed to investigate the impact of therapeutic AC after biological AVR on patient outcome and whether the presence of POAF affects decision making on anti-thrombotic management.

Methods

Within this prospective observational study, 200 individuals that underwent biological AVR surgery were enrolled. Participants were followed prospectively until the primary study endpoint was reached. Multivariate logistic regression analysis was performed to elucidate the effect of therapeutic AC on outcome.

Results

Overall, 106 individuals received therapeutic AC at the time of discharge. The fraction of patients presenting with POAF was balanced between individuals receiving AC and the non-AC subgroup (p = 0.617). After a median follow-up time of 1418 days, 31 (15.5%) individuals died, referring to 15 (13.9%) POAF-free patients and 16 (17.4%) with POAF. We observed a strong inverse association of therapeutic AC and cardiovascular mortality, which remained stable after adjustment for potential confounders showing a HR of 0.437 (95% CI 0.202–0.943; p = 0.035), while bleeding risk was comparable (p = 0.680).

Conclusion

Within this investigation, therapeutic AC showed a strong and independent inverse association with long-term mortality in patients that underwent biological AVR. Although POAF is associated with thromboembolic adverse events, the development of this arrhythmia did not affect decision-making of the anti-thrombotic management.

中文翻译：

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生物主动脉瓣置换术后抗血栓治疗策略对预后的影响

目的

接受外科生物主动脉瓣置换术 (AVR) 的患者的最佳抗血栓治疗是一个持续讨论的问题。此外，到目前为止，尚未明确研究生物 AVR 后抗血栓治疗策略的预后影响以及短期术后心房颤动 (POAF) 患者抗凝策略 (AC) 的真实数据。因此，本研究旨在探讨生物 AVR 后治疗性 AC 对患者预后的影响，以及 POAF 的存在是否影响抗血栓管理的决策制定。

方法

在这项前瞻性观察研究中，有 200 名接受过生物 AVR 手术的个体被纳入。对参与者进行前瞻性随访，直至达到主要研究终点。进行多变量逻辑回归分析以阐明治疗性 AC 对结果的影响。

结果

总体而言， 106 人在出院时接受了治疗性 AC。出现 POAF 的患者比例在接受 AC 和非 AC 亚组的个体之间是平衡的 ( p  = 0.617)。中位随访时间为 1418 天后，31 人 (15.5%) 死亡，其中 15 人 (13.9%) 没有 POAF，16 人 (17.4%) 有 POAF。我们观察到治疗性 AC 与心血管死亡率呈强烈负相关，在调整潜在混杂因素后保持稳定，显示 HR 为 0.437（95% CI 0.202–0.943；p = 0.035），而出血风险相当（p  = 0.680）。

结论

在这项调查中，治疗性 AC 显示出与接受生物 AVR 的患者的长期死亡率呈强烈且独立的负相关。尽管 POAF 与血栓栓塞不良事件有关，但这种心律失常的发展并不影响抗血栓管理的决策。