Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Division of Cardiac Surgery, University of Ottawa Heart Institute (Drs Toeg and Ruel) (email@example.com), and Department of Family Medicine, University of Ottawa Bruyere Research Institute (Dr Bjerre), Ottawa, Ontario, Canada.
To the Editor: Dr Mérie and colleagues reported that discontinuation of warfarin treatment within 6 months after bioprosthetic aortic valve replacement (AVR) surgery was associated with increased cardiovascular death.1 We think that several limitations and biases could have affected their conclusions.
Compared with the 3194 patients who received warfarin, aspirin monotherapy was used infrequently in this study (n = 181); furthermore, 700 patients received no aspirin or warfarin therapy, which is in conflict with recommended international practice standards.2,3 Reasons motivating the choice of anticoagulation treatment option were not provided.
Toeg HD, Bjerre LM, Ruel M. Warfarin Treatment After Bioprosthetic Aortic Valve Replacement. JAMA. 2013;309(12):1225-1226. doi:10.1001/jama.2013.1972