Thromboembolic and Bleeding Complications Due to Oral Anticoagulation following an Isolated Mitral Valve Repair

Objectives: Oral anticoagulation is routinely prescribed for three months following an isolated mitral valve repair (MVr) in Germany. However, benefits of oral anticoagulation are questionable, and risks are unknown in otherwise healthy patients. We aimed to examine the risk of anticoagulation-related complications over the period of three months after isolated MVr.

Methods: We retrospectively identified patients who underwent an isolated MVr during a period of nine years (2011–2019) from our institutional database. We excluded all patients with a history of atrial fibrillation and concomitant surgeries. Primary endpoint was the incidence of thromboembolic and bleeding events under oral anticoagulation during the first three postoperative months. Follow-up protocol consisted of structured clinical questionnaire.

Result: A total of 433 consecutive patients (mean age: 57.8 ± 12.9 years, 69% male) were analyzed. Mean log EuroSCORE was 0.9 ± 0.5% in the whole study cohort. Four (0.9%) patients died during the follow-up period including three in-hospital deaths. During the follow-up period, three thromboembolic events (0.7%) occurred in the form of transient ischemic attacks. All three patients were hospitalized for monitoring. The prevalence of hemorrhagic events was 6.9% (n = 30) including pericardial effusion (n = 11), epistaxis (n = 11), hematuria (n = 5), hemothorax (n = 2) and inguinal hematoma (n = 1). All bleeding events occurred after hospital discharge. Hospital readmission was necessary in 12 patients. Of note, one patient evolved a cumarin induced skin necrosis, which is a side effect of oral anticoagulation, and required bilateral forefoot amputation.

Conclusion: Thromboembolic complications following an isolated mitral valve repair are rare during three months oral anticoagulation. However, oral anticoagulation with vitamin K antagonists is associated with a substantial risk of bleeding events, which often require rehospitalization and reintervention. The necessity of oral anticoagulation following isolated mitral valve repair in patients with a stable sinus rhythm should be reevaluated by subsequent prospective studies.

Publication History

Article published online:
19 February 2021