Warfarin Cuts Mortality, Thromboembolism After Valve Replacement

Jan 05, 2024

THURSDAY, Jan. 4, 2024 (HealthDay News) — Warfarin use after bioprosthetic surgical aortic valve replacement (sAVR) is associated with lower all-cause mortality and a decreased risk for thromboembolism compared with not receiving warfarin, according to a study published in the December issue of the Mayo Clinic Proceedings.

Ying Huang, M.D., Ph.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues compared all-cause mortality and thromboembolic events in patients undergoing sAVR receiving anticoagulation with warfarin (≥30 days of continuous prescription coverage after sAVR) versus patients with no systemic anticoagulation. The analysis included 10,589 adult patients having bioprosthetic sAVR with or without coronary artery bypass from 2007 through 2019 (2,930 pairs of propensity score-matched patients).

The researchers found that overall mortality was lower for the warfarin group than for the nonwarfarin group (hazard ratio [HR], 0.68; 95 percent confidence interval [CI], 0.47 to 1.00; P = 0.047). There was also a trend toward a decreased cumulative incidence of thromboembolic events (subdistribution HR [SHR], 0.62; 95 percent CI, 0.35 to 1.07; P = 0.09). For major bleeding events, cumulative incidence was higher for the warfarin group versus the nonwarfarin group (SHR, 1.94; 95 percent CI, 1.28 to 2.94; P = 0.002). In a subgroup analysis of patients undergoing isolated sAVR, results were similar.

“Our research finds that the small increased hazard of bleeding (4 percent versus 2.3 percent) may be an acceptable risk given the benefits in terms of mortality risk as well as reduced risk of thromboembolism,” coauthor Hartzell Schaff, M.D., also from the Mayo Clinic, said in a statement.

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