Anticoagulation therapy after bioprosthetic aortic valve replacement in Dutch cardiothoracic centres: acceptance of guidelines does not lead to overall implementation†.

In 2012, the Netherlands Association of Cardiothoracic Surgery accepted the new guidelines of the European Association for Cardio-Thoracic Surgery on antiplatelet and anticoagulation management in cardiac surgery. The aim of our study was to evaluate knowledge and implementation of these guidelines in Dutch cardiothoracic centres 8 months later, specifically after biological aortic valve replacement. One month prior to and 8 months after acceptance of the new guidelines, a questionnaire was sent to all 16 Dutch cardiothoracic centres about their current anticoagulation management after biological aortic valve replacement, their knowledge and implementation of the guidelines. All centres returned the questionnaire. Fifteen centres declared knowledge of the guidelines of which two adjusted their anticoagulation therapy. Four declared they did not follow the guidelines. However, of the remaining 11 centres, only 7 followed the guidelines. Between the centres, current anticoagulation therapy varied from aspirin to coumarin with different dosages and durations. Despite acceptance of the guidelines, only 7 of 16 centres followed them, and there remains great variability in the postoperative anticoagulation management after biological aortic valve replacement in Netherlands.