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 .
Combined warfarin and antiplatelet therapy after St. Jude Medical valve replacement for mitral valve disease.
OBJECTIVES The clinical effect of combined warfarin and antiplatelet therapy on the incidence of stroke and postoperative complications after mitral ( plus aortic ) valve replacement was studied and compared with that observed with warfarin therapy alone . BACKGROUND It has been reported that combined warfarin and antiplatelet therapy may be effective but may be associated with an increased hemorrhagic risk . Therefore , definite benefits of the treatment in patients with an implanted prosthetic valve have not been clearly documented . METHODS Between January 1980 and December 1992 , 195 patients with a St. Jude Medical valve at the mitral ( plus aortic ) position were assigned to receive treatment with either warfarin alone ( 125 patients ) or warfarin plus antiplatelet agents ( 70 patients ) , such as dipyridamole ( 150 or 300 mg daily , 14 patients ) or ticlopidine ( 200 or 400 mg daily , 56 patients ) . A minimal dose of aspirin ( 10 to 40 mg ) was added ( 29 patients ) if the maximal platelet aggregation rate by collagen was not reduced . The target thrombotest level was 10 % to 20 % . RESULTS The two treatment groups were similar with regard to gender and age distribution . The number of patients with atrial fibrillation , left atrial thrombus , history of previous stroke , simultaneous aortic valve operation and previously performed valve procedures were comparable in the two groups . Actuarial survival rate at 10 years was 98.3 + /- 1.7 % ( mean + /- SD ) in the warfarin plus antiplatelet group and 90.3 + /- 3.2 % in the warfarin group ( p < 0.05 at 1 and 9 to 12 years ) . The actuarial stroke-free rate at 10 years was 95.3 + /- 3.4 % and 84.3 + /- 3.8 % , respectively ( p < 0.05 by the generalized Wilcoxon test ) . The actuarial complication-free rate at 10 years was 89.4 + /- 4.3 % and 67.9 + /- 4.8 % , respectively ( p < 0.05 by the generalized Wilcoxon test ) . No hemorrhagic complications were seen in the warfarin plus antiplatelet group . CONCLUSIONS The results strongly indicate the effectiveness and safety of combined warfarin plus antiplatelet treatment after St. Jude Medical valve replacement for mitral ( plus aortic ) valve disease
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 .