Optimal Intensity for Oral Anticoagulation in Patients with Prosthetic Heart Valves

Alexander G. G. Turpie

doi:10.1055/s-0038-1659982

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 1997; 17(03): 158-160
DOI: 10.1055/s-0038-1659982

Originalarbeiten/Original Articles

Schattauer GmbH

Optimal Intensity for Oral Anticoagulation in Patients with Prosthetic Heart Valves

Alexander G. G. Turpie

¹Department of Medicine, McMaster University and Hamilton Civic Hospitals Hamilton, Ontario, Canada

› Institutsangaben

Abstract

Summary

Antithrombotic therapy in patients with heart valve replacement has been placed on a firm scientific footing based on a number of prospective clinical trials. Patients with bioprostheses in the mitral position require a minimal of 3 months oral anticoagulants at a target INR of 2.0-3.0. Patients with bioprostheses with additional risk factors should receive oral anticoagulants indefinitely. Patients with mechanical prostheses require life-long anticoagulants at a target INR of 2.5-3.5. The addition of antiplatelet drugs to anticoagulants improves the outcome particularly in patients at risk of vascular disease.

Keywords

Prosthetic heart valve replacement - anticoagulant therapy - antiplatelet therapy - embolism - haemorrhage - clinical trials

Volltext

Referenzen

REFERENCES
1 Stein P.D, Alpert J.S, Copeland J.G, Dalen J.E, Turpie A.G.G. Antithrombotic therapy in patients with mechanical and bioprosthetic heart valves. Chest 1995; 108: 371S-379S.
2 Hirsh J, Dalen J.E, Deykin D, Poller L, Bussey H.I. Oral anticoagulants: Mechanism of action, clinical effectiveness and optimal therapeutic range. Chest 1995; 108: 231S-246S.
3 Turpie A.G.G, Gunstensen J, Hirsh J, Nelson H, Gent M. A randomized trial comparing two intensities of oral anticoagulant therapy following tissue heart valve replacement. Lancet 1988; i: 1242-5.
4 Saour J.N, Sieck J.O, Gallus A.S. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med 1990; 332: 428-32.
5 Altman P, Rouvier J, Gurfinkel E. et al. Comparison of two levels of anticoagulant therapy in patients with substitute heart valves. J Thorac Cardiovasc Surg 1991; 101: 427-31.
6 Cannegieter S.C, Rosendaal F.R, Wintzen A.R. et al. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 1995; 333 (01) 11-7.
7 Turpie A.G.G, Gent M, Laupacis A. et al. A double-blind randomized trial of acetylsali-cylic acid (100 mg) versus placebo in patients treated with oral anticoagulants following heart valve replacement. N Engl J Med 1993; 329: 1365-9.
8 Pouleur H, Buyse M. Effects of dipyridamole in combination with anticoagulant therapy on survival and thromboembolic events in patients with prosthetic heart valves. A meta-analysis of the randomized trials. J Thorac Cardiovasc Surg 1995; 110: 463-6.
9 Altman R, Rouvier J, Gurfinkel E, Scazziota A, Turpie A.G.G. Comparison of high-dose with low-dose aspirin in patients with mechanical heart valve replacement treated with oral anticoagulant. Circulation 1996; 94 (09) 2113-6.
10 Hayashi J.I, Nakazawa S, Oguma F, Miyamura H, Eguchi S. Combined warfarin and antiplatelet therapy after St. Jude mechanical vale replacement for mitral valve disease. J Am Coll Cardiol 1994; 23: 672-7.
11 Chesebro J.G, Fuster V, Elveback L.R. et al. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol 1983; 51: 1537-41.