Anti Coagulation Survey Final Results Slides PDF

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Anticoagulation Therapy after Aortic

Tissue Valve ReplacementFinal Results

CTSNet Editors,

Valve Technology Center



6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 2

Objectives

Primary: To determine the frequency of awareness among CTSNetsurgeons of the American College of Cardiology guidelines for post-op

warfarin therapy in patients with tissue valve replacement.

Secondary: To determine whether awareness of these guidelines

affects anticoagulation practices following aortic tissue valve

replacement (ATVR).




Methods

Study Population: Surgeon members of CTSNet who perform aortic

tissue valve replacement (ATVR) procedures.

Recruitment: Blast email notification of online survey instrument.

Announcement on CTSNet Home Page and Valve Technology Center

home page.

Design: Cross-sectional study. Surgeons completed online survey

accessed through www.CTSNet.org. Member login required. Single

submission. June 30, 2003 – August 28, 2003.

Analysis: Descriptive statistics.

http://www.ctsnet.org/




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Results: Awareness of ACC Guidelines

726 CTSNet-member surgeons completed the survey. – 79% were aware of ACC post-op warfarin guidelines

– 21% were not aware of the ACC guidelines

The following results are segmented as follows:

– All respondents

– Know ACC Guidelines

– Don’t Know ACC Guidelines

Note: ATVR = Aortic Tissue Valve Replacement



Region of Practice

Region of Respondent's Practice

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

A s i a

C a n a

d a

E u r o

p e

U n i t e

d S t a

t e s

O t h e

r

Region of Practice

P e r c e n t o f R e s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



ATVR Procedures Performed Last Year

Number of Aortic Tissue Valve ReplacementProcedures Performed Last Year

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

< 20 21-

30

31-

40

41-

50

51-

60

61-

70

> 70

Number of Cases

P e r c e

n t o f R e s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



Change in Procedure Volume from Previous Year

Change in Procedure Volume from Previous Year

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%60.0%

70.0%

80.0%

Up Down

Change in Procedure Volume

P e r c e

n t o f R e s p o n

d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



Percent of ATVR Patients with Comorbidities

Requiring Post-op Warfarin Therapy

Percent of ATVR Patients With Comorbidities that wouldRequire Warfarin Therapy During Post-op Hospital Stay

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

0 - 1 0

%

1 1 - 2

0 %

2 1 - 3

0 %

3 1 - 4

0 %

4 1 - 5 0

%

5 1 - 6

0 %

6 1 - 7 0

%

7 1 - 8

0 %

8 1 - 9

0 %

9 1 - 1

0 0 %

Percentage of ATVR Patients with

Comorbidities that Require Therapy

P e

r c e n t o f R e s p

o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



Expectation of Warfarin Treatment in ATVR Patients

without Comorbidities

General Expectation That Most ATVR Patients WithoutComorbidies Need to be Treated with Warfarin

0.0%

20.0%

40.0%

60.0%

80.0%

Yes No

Expectation Most ATVR Patients

Without Comorbidities Require

Therapy

P e r

c e n t o f R e s p o

n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



Percent Patients without Comorbidities Treated with

Warfarin for 3 Months after ATVR

Percent of Respondent's Patients without ComorbiditiesTreated with Warfarin Therapy for Three Months Post ATVR

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

0 - 1 0

%

1 1 - 2

0 %

2 1 - 3

0 %

3 1 - 4

0 %

4 1 - 5 0

%

5 1 - 6

0 %

6 1 - 7 0

%

7 1 - 8

0 %

8 1 - 9

0 %

9 1 - 1

0 0 %

Percent of Patients

P e r c e n t o f R e s p o

n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines



Belief that Post-Op Warfarin Rx Increases Length of

Stay in ATVR Patients without Comorbidities

Belief that Post-op Warfarin Therapy Following ATVRIncreases Hospital Stay in Patients Without Comorbidities

0.0%10.0%

20.0%

30.0%

40.0%

50.0%60.0%

70.0%

80.0%

Yes No

Belief Post-op Warfarin Therapy

Increases Hospital Stay

P e r c e n t o f R e s p o n

d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines




Average Increase in Length of Stay

Average No. of Days Post-op Warfarin Therapy FollowingATVR Increases Hospital Stay in Patients Without

Comorbidities

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

1 2 3 4

Average Number of Days

P

e r c e n t o f

R e

s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACCGuidelines




Belief Anti-platelet Therapy is an Acceptable

Alternative to Warfarin Therapy

Belief that Anti-platelet Therapy is an Acceptable Alternativeto Warfarin Therapy after ATVR in Patients without

Comorbities

0.0%

10.0%20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Yes No Sometimes


P

e r c e n t o f

R e

s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACCGuidelines




Prescription of Anti-platelet Therapy in ATVR

Patients without Comorbidities

Percentage of Respondent's ATVR Patients withoutComorbidities Prescribed Anti-platelet Therapy

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

0 - 1 0

%

1 1 - 2

0 %

2 1 - 3

0 %

3 1 - 4

0 %

4 1 - 5 0

%

5 1 - 6

0 %

6 1 - 7 0

%

7 1 - 8

0 %

8 1 - 9

0 %

9 1 - 1

0 0 %


P e r c e n t o f

R e s p o n d e n

t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines




Safety, LOS and Cost with Anti-platelet Therapy

Alone in ATVR Patients without Comorbidities

Belief Anti-platelet Therapy Alone in ATVR Patientswithout Comorbidities Adequately Addresses Patient

Safety While Reducing LOS and Cost of Care

0.0%

20.0%

40.0%

60.0%

80.0%

Yes No

Belief Anti-platelet Therapy

Alone Addresses Patient Safety

P e r c e n t o f

R e s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines




Belief in Anti-platelet Therapy as Post-op Standard

Belief Anti-platelet Therapy Should be Post-op Standardof Care Following ATVR in Patients Without

Comorbidities

0.0%10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Yes No Sometimes

Belief Anti-platelet Therapy

Should be Standard of Care

P e r c e n t o f

R

e s p o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines




Belief Warfarin Therapy for Three Months NoLonger Standard of Care in ATVR Patients

without Comorbidities

Belief Warfarin Therapy for Three Months is No Longer

Standard of Care after ATVR in Patients without

Comorbidities

0.0%

20.0%

40.0%

60.0%

80.0%

Yes No

Belief Warfarin Therapy is No

Longer Standard of Care

P e r

c e n t o f

R e s p

o n d e n t s

All Respondents

Know ACC Guidelines

Don't Know ACC

Guidelines




Conclusions

Most respondents (80%) are familiar with the ACC guidelines on

anticoagulation therapy following aortic tissue valve replacement.

Yet, most respondents do not strictly adhere to those guidelines.

Many surgeons believe that anti-platelet therapy, rather than

warfarin, may be adequate following aortic tissue valve

replacement in patients without comorbidities.

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