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 .
Ticagrelor versus clopidogrel in patients with acute coronary syndromes.
BACKGROUND Ticagrelor is an oral , reversible , direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel . METHODS In this multicenter , double-blind , r and omized trial , we compared ticagrelor ( 180-mg loading dose , 90 mg twice daily thereafter ) and clopidogrel ( 300-to-600-mg loading dose , 75 mg daily thereafter ) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome , with or without ST-segment elevation . RESULTS At 12 months , the primary end point -- a composite of death from vascular causes , myocardial infa rct ion , or stroke -- had occurred in 9.8 % of patients receiving ticagrelor as compared with 11.7 % of those receiving clopidogrel ( hazard ratio , 0.84 ; 95 % confidence interval [ CI ] , 0.77 to 0.92 ; P<0.001 ) . Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points , as well as myocardial infa rct ion alone ( 5.8 % in the ticagrelor group vs. 6.9 % in the clopidogrel group , P=0.005 ) and death from vascular causes ( 4.0 % vs. 5.1 % , P=0.001 ) but not stroke alone ( 1.5 % vs. 1.3 % , P=0.22 ) . The rate of death from any cause was also reduced with ticagrelor ( 4.5 % , vs. 5.9 % with clopidogrel ; P<0.001 ) . No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups ( 11.6 % and 11.2 % , respectively ; P=0.43 ) , but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting ( 4.5 % vs. 3.8 % , P=0.03 ) , including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types . CONCLUSIONS In patients who have an acute coronary syndrome with or without ST-segment elevation , treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes , myocardial infa rct ion , or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding . ( Clinical Trials.gov number , NCT00391872 .
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 .