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 .
Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial
BACKGROUND Mechanical reperfusion with stenting for ST-elevation myocardial infa rct ion ( STEMI ) is supported by dual antiplatelet treatment with aspirin and clopidogrel . Prasugrel , a potent and rapid-acting thienopyridine , is a potential alternative to clopidogrel . We aim ed to assess prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention ( PCI ) for STEMI . METHODS We undertook a double-blind , r and omised controlled trial in 707 sites in 30 countries . 3534 participants presenting with STEMI were r and omly assigned by interactive voice response system either prasugrel ( 60 mg loading , 10 mg maintenance [ n=1769 ] ) or clopidogrel ( 300 mg loading , 75 mg maintenance [ n=1765 ] ) and were unaware of the allocation . The primary endpoint was cardiovascular death , non-fatal myocardial infa rct ion , or non-fatal stroke . Efficacy analyses were by intention to treat . Follow-up was to 15 months , with secondary analyses at 30 days . This trial is registered with Clinical Trials.gov , number NCT00097591 . FINDINGS At 30 days , 115 ( 6.5 % ) individuals assigned prasugrel had met the primary endpoint compared with 166 ( 9.5 % ) allocated clopidogrel ( hazard ratio 0.68 [ 95 % CI 0.54 - 0.87 ] ; p=0.0017 ) . This effect continued to 15 months ( 174 [ 10.0 % ] vs 216 [ 12.4 % ] ; 0.79 [ 0.65 - 0.97 ] ; p=0.0221 ) . The key secondary endpoint of cardiovascular death , myocardial infa rct ion , or urgent target vessel revascularisation was also significantly reduced with prasugrel at 30 days ( 0.75 [ 0.59 - 0.96 ] ; p=0.0205 ) and 15 months ( 0.79 [ 0.65 - 0.97 ] ; p=0.0250 ) , as was stent thrombosis . Treatments did not differ with respect to thrombolysis in myocardial infa rct ion ( TIMI ) major bleeding unrelated to coronary-artery bypass graft ( CABG ) surgery at 30 days ( p=0.3359 ) and 15 months ( p=0.6451 ) . TIMI life-threatening bleeding and TIMI major or minor bleeding were also similar with the two treatments , and only TIMI major bleeding after CABG surgery was significantly increased with prasugrel ( p=0.0033 ) . INTERPRETATION In patients with STEMI undergoing PCI , prasugrel is more effective than clopidogrel for prevention of ischaemic events , without an apparent excess in bleeding
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 .