Anticoagulation and bioprosthetic aortic valve replacement: Sense and nonsense

A recent publication in JAMA recommends that warfarin therapy is indicated for the first 6 months after an aortic valve replacement using a bioprosthesis has taken place. It is regrettable that a well-respected journal like JAMA has published a paper that includes an obviously imbalanced comparison of non-randomized study groups and misinterpreted study results. The recommendations derived from this study are unfounded and - if implemented - may cause great harm, in particular to the frail and elderly bioprosthetic valve recipient. Given the ongoing debate on optimal anticoagulation strategies after bioprosthetic aortic valve replacement, the time is ripe for a randomized controlled trial with a sufficient sample size that allows for meaningful subgroup analyses to be conducted. This would provide a solid base of evidence for the individualized tailoring of postoperative anticoagulation management of bioprosthetic aortic valve recipients.