A lower daily dose of aspirin ( < 100 mg ) may be associated with a lower major bleeding risk than higher doses .
Adding antiplatelet therapy , either dipyridamole or low-dose aspirin , to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves .
The risk of major bleeding is increased with antiplatelet therapy .
These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events .
The effectiveness and safety of low-dose aspirin ( 100 mg daily ) appears to be similar to higher-dose aspirin and dipyridamole .
BACKGROUND Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism .
Oral anticoagulation alone , or the addition of antiplatelet drugs , has been used to minimise this risk .
An important issue is the effectiveness and safety of the latter strategy .
OBJECTIVES This is an up date of our previous review ; the goal was to create a valid synthesis of all available , method ologically sound data to further assess the safety and efficacy of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulant monotherapy in patients with prosthetic heart valves .
Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial.
OBJECTIVE Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation . Up to date , however , results of r and omized studies comparing antiplatelet agents and oral anticoagulation have not been reported . The aim of this study was to compare the efficacy and safety of triflusal ( an antiplatelet agent ) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis . METHODS In this prospect i ve , multicentric , r and omized , open pilot trial , patients were assigned to treatment with triflusal ( 600mg/d ) or acenocoumarol ( target INR 2.0 - 3.0 ) . Study medication was started 24 - 48h after valve replacement with a bioprosthesis , and continued for 3 months . Four follow-up visits were scheduled : baseline , and at 1 , 3 and 6 months thereafter . The primary end-point was a composite of the rate of thromboembolism , severe hemorrhage and valve-related mortality . RESULTS A total of 193 patients were included ( 97 received triflusal and 96 acenocoumarol ) , with a mean age of 72.5 years . Half were men . Aortic valve replacement was performed in 181 patients ( 93.8 % ) , mitral valve replacement in 10 patients ( 5.2 % ) and double valve replacement in 2 ( 1.0 % ) . Hospital mortality was 11 ( 5.7 % ) . Primary outcome was recorded in 9 patients with triflusal ( 9.4 % ) and in 10 patients with acenocoumarol ( 11 % ) . There were nine episodes ( 4.7 % ) of thromboembolism , six in the triflusal group and three in the acenocoumarol group , and three episodes of permanent neurological deficits , one in the triflusal group and two in the acenocoumarol group . Severe hemorrhage : nine episodes , six in the acenocoumarol group and three in the triflusal group . None of the observed differences in efficacy were statistically significant . Regarding safety , three patients in triflusal group reported at least one hemorrhage , compared to 10 in acenocoumarol group ( P=0.048 ) . CONCLUSIONS There were no significant differences in efficacy between both groups , however , triflusal showed a significantly lower incidence of bleeding episodes
A lower daily dose of aspirin ( < 100 mg ) may be associated with a lower major bleeding risk than higher doses .
Adding antiplatelet therapy , either dipyridamole or low-dose aspirin , to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves .
The risk of major bleeding is increased with antiplatelet therapy .
These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events .
The effectiveness and safety of low-dose aspirin ( 100 mg daily ) appears to be similar to higher-dose aspirin and dipyridamole .
BACKGROUND Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism .
Oral anticoagulation alone , or the addition of antiplatelet drugs , has been used to minimise this risk .
An important issue is the effectiveness and safety of the latter strategy .
OBJECTIVES This is an up date of our previous review ; the goal was to create a valid synthesis of all available , method ologically sound data to further assess the safety and efficacy of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulant monotherapy in patients with prosthetic heart valves .