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Comparing Antithrombotic Strategies after Bioprosthetic Aortic Valve Replacement: A Systematic Review

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Comparing Antithrombotic
Strategies after Bioprosthetic Aortic Valve Replacement: A Systematic Review

Principal Investigator: Joel Papak, MD
Co-Investigators: Joe Chiovaro, MD; North Noelck, MD; Laura Healy, PhD; Michele Freeman, MPH; Robin Paynter, MLIS; Allison Low, BA; Karli Kondo, PhD; Owen McCarty, PhD; Devan Kansagara, MD



Evidence-based Synthesis Program (ESP) Center, VA Portland Health Care System, Portland, OR

Washington (DC): Department of Veterans Affairs; January 2018.

Download PDF: Complete Report, Executive Summary, Report, Appendices



Antithrombotic Use in the Year After Bioprosthetic Aortic Valve Replacement in the Veterans Health Administration System


Antithrombotic Use in the Year After Bioprosthetic Aortic Valve Replacement in the Veterans Health Administration System

This report is a companion to the systematic review comparing antithrombotic strategies after bAVR produced in 2017 by the Evidence-based Synthesis Program Center in Portland, Oregon

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Introduction

The use of bioprosthetic aortic valves placed surgically and with a transcatheter approach is a common treatment for valvular heart disease. While most patients are treated with anticoagulant and/or antiplatelet therapy for a period of time after the procedure, the optimal antithrombotic regimen and duration after placement of a bioprosthetic aortic valve is unclear, and both guideline recommendations and practice patterns vary significantly. This systematic review aims to broadly summarize the comparative benefits and harms for various anticoagulation strategies following surgical or transcatheter implantation of a bioprosthetic aortic valve, and to determine whether effects differed according to thromboembolic risk profile or concomitant procedure.

Key Questions


Key Questions 1 and 2: What are the comparative benefits and harms of antithrombotic strategies for patients who have had bAVR?

KQ1-2A. Do the benefits/harms differ according to thromboembolic risk profile?

KQ1-2B. Do the benefits/harms differ according to concomitant procedure (eg CABG)?

Key Question 3: What are the comparative benefits and harms of antithrombotic strategies for patients who have TAVR?

KQ3A. Do the benefits/harms differ according to thromboembolic risk profile?

KQ3B. Do the benefits/harms differ according to concomitant procedure (eg, CABG)?

See also

Comparing Antithrombotic Strategies after Aortic Valve Replacement (Management eBrief)

Comparing Antithrombotic Strategies after Bioprosthetic Aortic Valve Replacement: A Systematic Review (Cyberseminar)

Papak J, Chiovaro J, Noelck N et al. Antithrombotic Strategies After Bioprosthetic Aortic Valve Replacement: A Systematic Review. Annals of Thoracic Surgery. 2019;107(5):1571-1581. https://doi.org/10.1016/j.athoracsur.2018.10.016