Anticoagulation after Mitral Valve Repair.

The use of anticoagulation after mitral valve repair varies widely, with one-third to one-half of patients discharged on an anticoagulant after surgery and the rest presumably treated with aspirin alone. 1 Suri R.M. Thourani V.H. He X. et al. Variation in warfarin thromboprophylaxis after mitral valve repair: does equipoise exist and is a randomized trial warranted?. Ann Thorac Surg. 2013; 95: 1991-1998 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ,2 Brown C.R. Sperry A.E. Cohen W.G. et al. Risk of stroke and major bleeding with vitamin K antagonist use after mitral valve repair. Ann Thorac Surg. 2023; 115: 957-965 Abstract Full Text Full Text PDF Scopus (1) Google Scholar To date, no prospective clinical trials address the risks and benefits of prescribing anticoagulation after mitral valve repair. Therefore, the net patient benefit or harm associated with anticoagulation in these patients, which depends on the interplay of excess bleeding with anticoagulation (a certainty) and a reduction in embolic events (a possibility), remains incompletely defined. In this issue of The Annals of Thoracic Surgery, Brown and coworkers 2 Brown C.R. Sperry A.E. Cohen W.G. et al. Risk of stroke and major bleeding with vitamin K antagonist use after mitral valve repair. Ann Thorac Surg. 2023; 115: 957-965 Abstract Full Text Full Text PDF Scopus (1) Google Scholar provide additional data to inform this discussion. Risk of Stroke and Major Bleeding With Vitamin K Antagonist Use After Mitral Valve RepairThe Annals of Thoracic SurgeryVol. 115Issue 4PreviewGuidelines are discordant on the use of a vitamin K antagonist (VKA) after mitral valve repair (MVr) to reduce the risk of cerebral embolic events. We performed an observational study among patients who underwent a MVr, without perioperative atrial fibrillation, to determine the risk of cerebral ischemic and major bleeding events with or without VKA. Full-Text PDF