Abstract 3446: Anticoagulation at Discharge After Mitral Valve Repair and Long-Term Mortality
Background: Patients undergoing mitral valve repair (MVRr) are often discharged on oral anticoagulation with coumadin. However, only patients in atrial fibrillation (AF) have a well-documented indication for oral anticoagulation after MVRr. Moreover, the influence of anticoagulation on the long-term outcome of patients who have undergone MVRr is not known.
Methods: We reviewed the records of 245 patients who underwent MVRr from 1996 to 2001 and assessed the association between oral anticoagulation and other clinical variables and the risk for death.
Results: The group comprised 95 women and 150 men with a mean age of 62.1 ± 14 years. None of the patients died in the hospital. An episode of AF at any time prior to discharge or AF at discharge was documented in 126 (57%) patients. At the time of discharge 159 patients received coumadin, while the remaining patients received aspirin except for two patients who received neither. At a median follow-up of 6.75 years, 30 patients died. The odds ratio of death for patients discharged on coumadin was 0.91 as compared to the patients discharged on aspirin (95% confidence interval 0.76 - 1.1; P = 0.33). After adjustment for different factors associated with outcome after MVRr, such as age, sex, low left ventricular ejection fraction, hypertension, diabetes mellitus and AF, there was no significant difference between the two treatment protocols [odds ratio of 0.94 (95% confidence interval 0.78 - 1.14; P = 0.54)]. On survival analysis (logrank test) no significant difference was found between the group of patients discharged on coumadin and the group of patients discharged on aspirin (P = 0.89).
Conclusion: In our study population, patients discharged on oral anticoagulation with coumadin after MVRr did not have a lower long-term mortality than patients discharged on aspirin. The optimal oral anticoagulation regimen for patients who have undergone MVRr should be determined in a randomized trial comparing anticoagulation regimens.