Antithrombotic Strategy in the Three First Months following Bioprosthetic Heart Valve Implantation

Heart valve prosthesis unquestionably improve quality of life and survival ofpatients with severe valvular heart disease, but the need for antithrombotic therapyto prevent thromboembolic complications is a major challenge to clinicians and theirpatients. Of the articles analyzed, most were retrospective series of cases orhistorical cohorts obtained from the database. The few published randomized trialsshowed no statistical power to assess the primary outcome of death or thromboembolicevent. In this article, we decided to perform a systematic literature review, in anattempt to answer the following question: what is the best antithrombotic strategy inthe first three months after bioprosthetic heart valve implantation (mitral andaortic)?After two reviewers applying the extraction criteria, we found 1968 references,selecting 31 references (excluding papers truncated, which combined bioprosthesiswith mechanical prosthesis, or without follow-up).Based on this literature review, there was a low level of evidence for anyantithrombotic therapeutic strategy evaluated. It´s therefore interesting to useaspirin 75 to 100 mg / day as antithrombotic strategy after bioprosthesis replacementin the aortic position, regardless of etiology, for patients without other riskfactors such as atrial fibrillation or previous thromboembolic event. In the mitralposition, the risk of embolism, although low, is more relevant than in the aorticposition, according to published series and retrospective cohorts comprised mostly ofelderly non-rheumatic patients.The current evidence is limited to have a consistent and safe level of evidenceregarding the best therapeutic strategy. Based on these studies, 75 to 100 mg/day ofaspirin is interesting as antithrombotic strategy after implantation of aorticbioprosthesis, regardless of etiology, for patients with no other risk factors suchas atrial fibrillation or previous thromboembolic event. As for mitral bioprosthesis,the risk of embolism, although low, is more relevant than in the aortic position,according to published series and retrospective cohorts - usually elderly nonrheumatic patients.