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Available online 18 June 2022
ACOD en pacientes con fibrilación auricular e intervención quirúrgica sobre la válvula mitral
DOAC in patients with mitral valve intervention and anticoagulation due to atrial fibrillation
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Víctor Expósito Garcíaa,
Corresponding author
vexposito@humv.es

Autor para correspondencia.
, Felipe Rodríguez Entema, Susana González Enríqueza, Santiago Catoya Villaa, Miguel Molina San Quiricoa, Manuel Lozano Gonzáleza, Andrea Teira Calderóna, Valentín Tascón Quevedob, Carlos Juárez Crespob, Enrique Palacio Portillac, José María de la Torre Hernándeza, Francisco Nistal Herrerab, Juan José Olalla Antolína
a Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
b Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
c Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
Received 08 April 2022. Accepted 27 May 2022
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Introducción y objetivos

El uso de anticoagulantes orales de acción directa (ACOD) en pacientes con fibrilación auricular (FA) e intervención sobre la válvula mitral (prótesis valvular biológica o reparación) se recoge en las guías como alternativa a los antagonistas de la vitaminaK (AVK). Sin embargo, existen escasas referencias en la literatura a esta población en la práctica real.

Métodos

Nuestro estudio incluye todos aquellos pacientes intervenidos en nuestro hospital de reparación o recambio valvular mitral por prótesis biológica entre 2014 y 2020, con indicación de anticoagulación por FA. Comparamos las tasas de eventos cerebrovasculares, hemorragias mayores y menores, y mortalidad, entre aquellos tratados con ACOD y con AVK.

Resultados

Seleccionamos 105 pacientes: 75 sometidos a recambio biológico y 30 a reparación. Tras un seguimiento medio de 2,8años, 41 pacientes se trataron exclusivamente con AVK y 64 iniciaron ACOD (34 como anticoagulante desde el inicio y 30 tras cambio desde el AVK). No hubo diferencias significativas en sus características basales en cuanto a edad, sexo, función renal o escalas de riesgo embólico/hemorrágico entre grupos. No hubo diferencias en la tasa de ictus y hemorragias mayores entre pacientes con AVK o ACOD (hemorragias mayores, AVK n=6, 8,4%; ACOD n=4, 11,7%; ictus/accidente isquémico transitorio, AVK n=5, 7,04%; ACOD 2, 5,8%), con 2 hemorragias intracraneales bajo AVK (2,8%).

Conclusiones

El uso de ACOD en una cohorte en la vida real de pacientes con intervención quirúrgica sobre la válvula mitral (prótesis biológica o reparación) es una alternativa eficaz y segura al AVK, sin diferencias en la tasa de eventos isquémicos o hemorrágicos.

Palabras clave:
Fibrilación auricular
Bioprótesis
Cirugía
Válvula mitral
Anticoagulación
Abstract
Introduction and objectives

Although the usage of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and intervention on the mitral valve (biological valve prosthesis or repair) is included in the clinical practice guidelines as an alternative to vitaminK antagonists (VKA), real world data in this scenario remain scarce.

Methods

Our study included all patients who underwent mitral valve replacement by biological prosthesis or mitral valve repair in our hospital between 2014 and 2020, with indication of anticoagulation due to AF. We compared rates of cerebrovascular events, major and minor bleeding, and mortality, between those treated with DOACs and VKAs.

Results

We selected 105 patients: 75 submitted to biological replacement and 30 to repair. After a mean follow-up of 2.8years, 41 patients were treated exclusively with VKA, and 64 started DOACs —34 as anticoagulant from the beginning, and 30 after switching from VKA. There were no significant differences in their baseline clinical characteristics in terms of age, sex, kidney function, or embolic or bleeding risk scales between groups. There were no differences in the rate of stroke and major bleeding between patients with VKA or DOAC (major bleeding, VKA n=6, 8.4% vs DOAC n=4, 11.7%; stroke/TIA, VKA n=5, 7.04% vs DOAC 2, 5.8%), with 2 intracranial hemorrhages under VKA (2.8%).

Conclusions

The use of DOACs in a real-life cohort of patients with mitral valve surgery (biological prosthesis or repair) is an effective and safe alternative to the use of VKAs, without differences in the rate of ischemic or hemorrhagic events.

Keywords:
Atrial fibrillation
Bioprothesis
Surgery
Mitral valve
Anticoagulation

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