Updated Guidance Issued on Valvular Heart Disease

APRIL 16, 2014
Updated Guidance Issued on Valvular Heart Disease

The updated valvular heart disease guidelines issued by the American Heart Association (AHA) and American College of Cardiology (ACC) now incorporate transcatheter aortic valve implantation (TAVI), which is now recommended for patients who are not candidates for surgery and would be expected to survive longer than 1 year after intervention. Surgical valve replacement remains the recommended treatment option for patients with severe aortic stenosis and a low/ intermediate surgical risk.

The updated guidelines are the first recommendations for aortic stenosis, mitral regurgitation, and other adult valvular heart diseases from the AHA/ACC since 2008. It was published in Circulation and the Journal of the American College of Cardiology and can be accessed at http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf.

The guidelines say that TAVI is a reasonable alternative to surgery for patients who have an indication for aortic valve replacement and a high surgical risk. It is not recommended for patients with a comorbidity burden that would cancel out any expected benefit from correcting the stenosis.

A new addition to the guideline is the 4-category disease classification system that moves from “at risk” to “progressive” to “asymptomatic severe,” to “symptomatic severe.” The guide also contains a risk assessment tool for all patients being considered for intervention.

The updated recommendations also lower the trigger points at which some patients should undergo intervention. For example, aortic valve replacement is recommended for asymptomatic patients with severe aortic stenosis and a left ventricular ejection fraction below 50% and is considered reasonable in asymptomatic patients with very severe aortic stenosis and a low surgical risk.

Dabigatran and Apixaban Approved for DVT Indications

The FDA approved apixaban (Eliquis) for the prevention of deep vein thrombosis (DVT) in adults who have undergone hip or knee replacement surgery.

The FDA also approved dabigatran (Pradaxa) for the treatment of DVT and pulmonary embolism (PE) in patients who have been treated with a parenteral anticoagulant for 5 to 10 days. It was also approved to reduce the risk of DVT/PE recurrence in patients who have been previously treated.

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