Original Title: Traitements antithrombotiques à la suite de chirurgies de remplacement de valves cardiaques

Authors' objectives: The most commonly diagnosed heart valve diseases are aortic valve stenosis and mitral valve insufficiency. Depending on the state of valve degeneration, the choice of therapy may be through a percutaneous route or a surgically invasive one. Following the intervention, the patient must follow an antithrombotic treatment including an anticoagulant and/or an antiplatelet therapy. However, recommendations from professional organizations contain several differences regarding the choice and duration of treatments to be prescribed. The Pharmacy Department therefore asked the Institute’s Health Technology Assessment Unit to determine the optimal use of antithrombotics following cardiac valve replacement surgery.

Authors' results and conclusions: The analysis of scientific publications cited in the practice guidelines, as well as the field evaluation of thrombosis and bleeding cases recorded at the Institute, made it possible to determine an evidence-based optimal use of antithrombotics.

Authors' recommendations: In patients who have undergone valve surgery with a mechanical prosthesis, it is recommended to use Aspirin™ 80 mg if the risk of bleeding is low, combined with long-term treatment of warfarin targeting an International Normalized Ratio (INR) of 2.5 (2.0 to 3.0) for aortic valve replacement and 3.0 (2.5 to 3.5) for mitral valve replacement. Following aortic valve replacement with a bioprosthesis, it is recommended to prescribe long-term treatment of Aspirin™ 80 mg without anticoagulant therapy if the patient is in sinus rhythm and there are no other indications to prescribe an anticoagulant. In patients who have undergone mitral valve replacement surgery with a bioprosthesis, it is recommended to use long-term Aspirin™ treatment initiated following surgery, in the absence of other indications for an oral anticoagulant, as well as a treatment with warfarin for three to six months with a target INR of 2.5 (2.0 to 3.0). A decision algorithm related to the optimal antithrombotic strategy following valve replacement surgery is available in a document attached to this report.

Project Status: Completed

URL for project: https://www.iucpq.ca/a-propos-de-nous/excellence/evaluation-des-technologies-et-modes-dintervention-en-sante/

Year Published: 2021

URL for published report: https://www.iucpq.ca/app/uploads/2024/06/rap_traitements_antithrombotiques_02-2021_vf.pdf

Requestor: Pharmacy Department

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval