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 .
[Coumarin combined with low-dose acetylsalicylic acid in the prevention of thromboembolic complications in patients with mitral and aortic valve prostheses].
Authors studied the effect of coumarin , and its combination with low-dose ( 125 mg/day ) acetylsalicylic acid in the prevention of thromboembolic complication during a 10-year period ( average 4.7 years ) in a r and omized trial of 296 patients aged 18 - 60 year with tilting disc type prosthetic heart valve ( 159 mitral and 137 aortic ) in sinus rhythm . In the group treated with coumarin ( 152 patients , 743.4 patient-years ) 4 cases ( 2 of them fatal ) of valve thrombosis , 12 cases of peripheral embolism and 9 cases ( 3 intracranial , 3 among them fatal ) of major bleeding were observed ; in the group treated with coumarin plus acetylsalicylic acid ( 144 patients , 638.7 patient-years ) 2 cases ( 1 of them fatal ) of valve thrombosis , 4 cases of peripheral embolism and 14 cases ( 3 of them fatal ) of major bleeding were observed . In the case of valve thromboses the difference between the two groups was non-significant but still clinical ly remarkable ; peripheral embolism occurred in significantly higher number ( p < 0.05 ) . There was no statistically significant difference of bleeding complications between the two groups . The results suggest that the combination of coumarin plus low-dose acetylsalicylic acid is more effective in the prevention of thromboembolic complications in patients with mitral and aortic prosthetic heart valve than coumarin alone ; the danger of bleeding complications seems to be acceptable with adequate control
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 .