PMID- 27487810
OWN - NLM
STAT- MEDLINE
DCOM- 20170717
LR  - 20181202
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 103
IP  - 1
DP  - 2017 Jan 1
TI  - Anticoagulation versus antiplatelet or no therapy in patients undergoing 
      bioprosthetic valve implantation: a systematic review and meta-analysis.
PG  - 40-48
LID - 10.1136/heartjnl-2016-309630 [doi]
AB  - OBJECTIVE: Use of vitamin K antagonist (VKA) versus antiplatelet (AP)/no therapy 
      following bioprosthetic valve implantation remains controversial. The aims of the 
      current study were to (a) systematically review the published literature 
      comparing the use of VKA versus AP/no treatment in such patients and (b) perform 
      a meta-analysis of the risks and benefits of using a VKA compared with AP/no 
      therapy. METHODS: Five databases were searched including PubMed, Medline, Embase, 
      Ovid and Cochrane for randomised clinical trials and observational studies 
      comparing VKA (group I) versus AP/no therapy (group II). Outcome was after 
      surgical intervention. Mantel-Haenszel odds ratio (OR) was calculated using 
      random-effects meta-analysis for the outcome. Heterogeneity was assessed by I(2) 
      statistics. A total of 14 studies were included (two randomised trials, 12 
      observational studies and one conference abstract, 31 740 patients). RESULTS: 
      Between groups I (VKA) and II (AP/no therapy), there were no differences in 
      thromboembolic events (145 (1%) vs 262 (1.5%), OR 0.96 (95% CI 0.60 to 1.52)), 
      all-cause mortality (351 (3.5%) vs 415 (2.9%), OR 1.48 (95% CI 0.87 to 2.50)) or 
      need for redo surgery (47 (3.3%) vs 55 (3.2%); OR 0.81 (95% CI 0.42 to 1.58)). 
      However, there were more bleeding events in group I versus group II (292 (2.6%) 
      vs 189 (1.1%); OR 2.26 (95% CI 1.67 to 3.05)). CONCLUSIONS: In a meta-analysis of 
      randomised and observational studies of VKA versus AP/no treatment in patients 
      undergoing bioprosthetic valve implantation, there was no benefit of adding a VKA 
      regarding thromboembolism or mortality. However, use of a VKA was associated with 
      increased risk of major bleeding.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://www.bmj.com/company/products-services/rights-and-licensing/.
FAU - Masri, Ahmad
AU  - Masri A
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Gillinov, A Marc
AU  - Gillinov AM
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Johnston, Douglas M
AU  - Johnston DM
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Sabik, Joseph F
AU  - Sabik JF
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Svensson, Lars G
AU  - Svensson LG
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Rodriguez, L Leonardo
AU  - Rodriguez LL
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Kapadia, Samir R
AU  - Kapadia SR
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Stewart, William J
AU  - Stewart WJ
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Grimm, Richard A
AU  - Grimm RA
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Griffin, Brian P
AU  - Griffin BP
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
FAU - Desai, Milind Y
AU  - Desai MY
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular 
      Institute, Cleveland, Ohio, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160803
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - *Bioprosthesis
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*adverse effects/methods
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Postoperative Care/methods
MH  - Thromboembolism/etiology/prevention & control
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2016/08/05 06:00
MHDA- 2017/07/18 06:00
CRDT- 2016/08/05 06:00
PHST- 2016/03/11 00:00 [received]
PHST- 2016/07/07 00:00 [revised]
PHST- 2016/07/10 00:00 [accepted]
PHST- 2016/08/05 06:00 [pubmed]
PHST- 2017/07/18 06:00 [medline]
PHST- 2016/08/05 06:00 [entrez]
AID - heartjnl-2016-309630 [pii]
AID - 10.1136/heartjnl-2016-309630 [doi]
PST - ppublish
SO  - Heart. 2017 Jan 1;103(1):40-48. doi: 10.1136/heartjnl-2016-309630. Epub 2016 Aug 
      3.