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Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis.
J Heart Valve Dis. 1999 Nov; 8(6):665-73.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been implanted in patients at the authors' institution. We present our experience of low-dose oral anticoagulation and antiplatelet therapy following SJM valve implantation.

METHODS

Among 2,585 patients (mean age 40.3 +/- 13.5 years) living in a rural environment, 865 underwent aortic valve replacement (AVR), 1,231 mitral valve replacement (MVR) and 489 double valve replacement (DVR). All patients received 2.5 mg/day warfarin and a combination of antiaggregation therapy (dypridamole 3 x 75 mg/day plus aspirin 100 mg/day), irrespective of their prothrombin time and cardiac rhythm.

RESULTS

Postoperatively, 139 adverse events occurred (51 in AVR patients, 58 in MVR, 30 in DVR). Operative mortality rate was 5.9%, 4.7% and 6.1%, respectively, in the three groups (overall mortality rate 5.4%). The most frequent cause of operative mortality was low cardiac output. During follow up, there were 88 anticoagulant hemorrhages (1.2%/patient-year (pt-yr)), 11 paravalvular leaks (0.2%/pt-yr), 52 thromboembolisms (0.7%/pt-yr), 60 mechanical valve thromboses (0.8%/pt-yr) and 78 reoperations (1.1%/pt-yr). These complications occurred in 101 patients after AVR, in 125 after MVR, and in 63 after DVR (4.2%, 3.7% and 4.6% per pt-yr, respectively). Patient age (p = 0.0004), concomitant surgery (p = 0.0017) and late valve-related complications (p = 0.0159) were statistically significant mortality factors after AVR. Previous surgery was a significant risk factor for operative mortality after MVR (p <0.05). Female gender (p = 0.0059) and age (p = 0.017) were significant risk factors for operative mortality after DVR (p <0.01).

CONCLUSIONS

Following implantation of the St. Jude Medical mechanical heart valve prosthesis, a fixed dose of 2.5 mg/day warfarin and combined dipyridamole/aspirin provided satisfactory results in terms of thrombosis, embolism and bleeding.

Authors+Show Affiliations

Yamak B
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Iscan Z
No affiliation info available
Mavitas B
No affiliation info available
Ulus AT
No affiliation info available
Katircioglu SF
No affiliation info available
Tasdemir O
No affiliation info available
Bayazit K
No affiliation info available

MeSH

Administration, OralAdolescentAdultAgedAged, 80 and overAnticoagulantsAortic ValveAspirinChildDipyridamoleDrug Therapy, CombinationFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedMitral ValvePlatelet Aggregation InhibitorsPostoperative CareProsthesis DesignRetrospective StudiesSurvival RateThromboembolismWarfarin

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10616246

Citation

Yamak, B, et al. "Low-dose Oral Anticoagulation and Antiplatelet Therapy With St. Jude Medical Heart Valve Prosthesis." The Journal of Heart Valve Disease, vol. 8, no. 6, 1999, pp. 665-73.
Yamak B, Iscan Z, Mavitas B, et al. Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis. J Heart Valve Dis. 1999;8(6):665-73.
Yamak, B., Iscan, Z., Mavitas, B., Ulus, A. T., Katircioglu, S. F., Tasdemir, O., & Bayazit, K. (1999). Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis. The Journal of Heart Valve Disease, 8(6), 665-73.
Yamak B, et al. Low-dose Oral Anticoagulation and Antiplatelet Therapy With St. Jude Medical Heart Valve Prosthesis. J Heart Valve Dis. 1999;8(6):665-73. PubMed PMID: 10616246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis. AU - Yamak,B, AU - Iscan,Z, AU - Mavitas,B, AU - Ulus,A T, AU - Katircioglu,S F, AU - Tasdemir,O, AU - Bayazit,K, PY - 2000/1/1/pubmed PY - 2000/1/1/medline PY - 2000/1/1/entrez SP - 665 EP - 73 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 8 IS - 6 N2 - BACKGROUND AND AIM OF THE STUDY: Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been implanted in patients at the authors' institution. We present our experience of low-dose oral anticoagulation and antiplatelet therapy following SJM valve implantation. METHODS: Among 2,585 patients (mean age 40.3 +/- 13.5 years) living in a rural environment, 865 underwent aortic valve replacement (AVR), 1,231 mitral valve replacement (MVR) and 489 double valve replacement (DVR). All patients received 2.5 mg/day warfarin and a combination of antiaggregation therapy (dypridamole 3 x 75 mg/day plus aspirin 100 mg/day), irrespective of their prothrombin time and cardiac rhythm. RESULTS: Postoperatively, 139 adverse events occurred (51 in AVR patients, 58 in MVR, 30 in DVR). Operative mortality rate was 5.9%, 4.7% and 6.1%, respectively, in the three groups (overall mortality rate 5.4%). The most frequent cause of operative mortality was low cardiac output. During follow up, there were 88 anticoagulant hemorrhages (1.2%/patient-year (pt-yr)), 11 paravalvular leaks (0.2%/pt-yr), 52 thromboembolisms (0.7%/pt-yr), 60 mechanical valve thromboses (0.8%/pt-yr) and 78 reoperations (1.1%/pt-yr). These complications occurred in 101 patients after AVR, in 125 after MVR, and in 63 after DVR (4.2%, 3.7% and 4.6% per pt-yr, respectively). Patient age (p = 0.0004), concomitant surgery (p = 0.0017) and late valve-related complications (p = 0.0159) were statistically significant mortality factors after AVR. Previous surgery was a significant risk factor for operative mortality after MVR (p <0.05). Female gender (p = 0.0059) and age (p = 0.017) were significant risk factors for operative mortality after DVR (p <0.01). CONCLUSIONS: Following implantation of the St. Jude Medical mechanical heart valve prosthesis, a fixed dose of 2.5 mg/day warfarin and combined dipyridamole/aspirin provided satisfactory results in terms of thrombosis, embolism and bleeding. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/10616246/Low_dose_oral_anticoagulation_and_antiplatelet_therapy_with_St__Jude_Medical_heart_valve_prosthesis_ DB - PRIME DP - Unbound Medicine ER -