Risk of Stroke and Major Bleeding With Vitamin K Antagonist Use After Mitral Valve Repair

BACKGROUND Guidelines are discordant on the use of a vitamin K antagonist (VKA) after mitral valve repair (MVr) to reduce the risk of cerebral embolic events. We performed an observational study among patients who underwent a MVr, without perioperative atrial fibrillation, to determine the risk of cerebral ischemic and major bleeding events with or without VKA. METHODS From 2004 to 2016, we included patients who underwent MVr, using a national administrative claims database. Those with preoperative atrial fibrillation and anticoagulant use were excluded. Patients were stratified based on the presence of a VKA. Inverse probability weighting with a Cox proportional hazard model was used. RESULTS After MVr, 754 patients were discharged on VKA and 1462 on no-VKA. We found no difference in the cu-mulative incidence for embolic stroke at 180 days (VKA: 2.21% vs no-VKA: 1.50%; hazard ratio, 1.35; P = .38). However, VKA patients had a significantly increased risk for any-cause major bleeding events at 180 days (VKA: 8.58% vs no-VKA: 4.21%; hazard ratio, 2.09; P < .001). VKA patients also had increased need for a pericardiocentesis/pericardial window at 30 days after discharge (VKA: 1.13% vs no-VKA: 0.37%; hazard ratio, 3.88; P = .025). CONCLUSIONS Our study suggests that VKA after MVr does not reduce the risk of cerebral embolic events but is associated with an increased risk of major bleeding events.

Automated summary

Guidelines have conflicting opinions on whether or not to use vitamin K antagonists (VKA) after mitral valve repair (MVr) to reduce the risk of cerebral embolic events. An observational study found that VKA does not decrease the risk of cerebral embolic events after MVr, but is associated with an increased risk of major bleeding events.