Prevalence of Guideline Discordant Aspirin use and Associated Adverse Events in Patients on Warfarin for Mechanical Valve Replacement.

BACKGROUND

For patients on warfarin for mechanical heart valve replacement, the 2020 American College of Cardiology and American Heart Association Guidelines recommend only adding aspirin in patients with a specific indication for antiplatelet therapy. This contrasts prior guidelines which recommended concomitant aspirin therapy. We sought to assess the prevalence of guideline discordant aspirin use among patients on warfarin for mechanical heart valve replacement and to compare adverse event rates among patients with and without concomitant aspirin.

METHODS

Patients on warfarin for mechanical heart valve replacement were identified from the Michigan Anticoagulation Quality Improvement Initiative (MAQI

RESULTS

Four hundred forty-four patients met inclusion criteria, with 341 (76.8%) on concomitant aspirin. The aspirin group was older (50.6 vs 46.3 years, p=0.028) and had more hypertension (57.8% vs 46.6%, p=0.046) but other patient characteristics were similar. The aspirin group had a higher rate of bleeding events (28.3 vs 13.3 per 100 patient-years, p<0.001) and bleed-related emergency department visits (11.8 vs 2.9 per 100 patient-years, p=0.001) compared to the non-aspirin group. There was no observed difference in rates of ischemic stroke (0.56 vs 0.48 per 100 patient-years, p=0.89).

CONCLUSION

A significant proportion of patients on warfarin for mechanical heart valve replacement are on guideline discordant aspirin. Aspirin deprescribing in select patients may safely reduce bleeding events.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest Brian Haymart, Xiaowen Kong, Mona Ali, Jordan K. Schaefer, Noelle Ryan, and Beverly Stallings report no conflicts of interest. James B. Froehlich reports grant funding from Blue Cross Blue Shield of Michigan, Fibromuscular Disease Society of America, and the PERT Consortium. Geoffrey D. Barnes reports receiving personal fees from Pfizer/Bristol Myers Squibb, Janssen, Bayer, Abbot Vascular, Sanofi, Anthos, and Boston Scientific and grand funding from NHLBI, Boston Scientific and Blue Cross Blue Shield of Michigan. He also reports being on the Board of Directors for Anticoagulation Forum. Scott Kaatz reports receiving personal fees from AstraZeneca, Bristol-Myers Squibb, Boston Scientific, Gilead, Inari, Janssen, Pfizer, Phase Bio and Antos. I receive grant funding from Osmosis Research, Janssen, Bristol-Myers Squibb, Bayer and NIH. I'm on the Board of Directors for Anticoagulation Forum, the PERT Consortium and the Scientific Advisory Board for the National Blood Clot Alliance.