No need for warfarin after isolated mitral valve repair, says study

Warfarin does not seem to provide additional benefit or risks following isolated mitral valve repair (MVr), reports a recent meta-analysis.

Drawing from the databases of PubMed, Embase, and Scopus, the researchers retrieved four studies eligible for quantitative synthesis regarding the postoperative thromboprophylactic efficacy of isolated MVr. Those that investigated combined operations or mitral valve replacement were excluded.

Together, the studies contributed a total of 3,986 patients. Pooled analysis showed no significant difference in terms of thromboembolic events between patients who were vs were not on warfarin (odds ratio [OR], 0.97, 95 percent confidence interval [CI], 0.72–1.31).

The analysis of bleeding events included 3,801 patients from three studies. Synthesis showed that bleeding likewise occurred at comparable frequencies between groups treated with vs without warfarin (OR, 1.10, 95 percent CI, 0.53–2.30).

Death was also unaffected by warfarin use. Three studies with 3,771 patients yielded a nonsignificant OR of 1.06 (95 percent CI, 0.28–4.05).

In terms of methodological quality, funnel plots for all three primary outcomes were symmetrical and showed no strong indication of publication bias.

“Recommendations from international guidelines on optimal thromboprophylaxis after mitral repair are controversial and based on underpowered observational studies,” the researchers said.

“[A]s the short-term use of postoperative warfarin does not appear to increase the risk of bleeding or impact survival, surgeons may continue to use it judiciously, depending on the expected thrombogenicity of the mitral repair technique used,” they added.