title: Anticoagulant therapy in children with prosthetic valves.
abstract: The purpose of this study was to evaluate the effectiveness and complications of several types of anticoagulant therapy in children with prosthetic valves. During a 7-year period ending April 1985, 130 children aged 1 to 19 years underwent left-sided valve replacement. Operative mortality was 3%, 5%, and 9%, respectively, for aortic, mitral, and aortic and mitral valve replacement. Among the 123 survivors, 32 (26%) had had aortic, 71 (58%) had had mitral, and 20 (16%) had had aortic and mitral valve replacement. Follow-up ranged from 2 months to 8.2 years, a total of 544 patient-years. The survivors were divided into three groups based on anticoagulant treatment: warfarin sodium, aspirin plus dipyridamole, and no anticoagulants. Among the patients who had aortic valve replacement, thromboembolic complications developed in 2.5% (2.5/100 patient-years) of the aspirin plus dipyridamole group and 5% of the group given no anticoagulants. Only the warfarin group (4%) experienced bleeding complications. Among the patients having mitral valve replacement, thromboembolic complications developed in 4% of the warfarin group, 3% of the aspirin plus dipyridamole group, and 11% of the no anticoagulant group. In addition, 2% of patients in the warfarin group experienced severe bleeding. Two fatal cerebrovascular accidents occurred, both in the aspirin plus dipyridamole group. Patients who received a mitral heterograft were not prescribed any anticoagulant medications, and no thromboembolic complications developed. Among patients having double-valve replacement, complications developed in 5% of the warfarin group and 27% of the group given no anticoagulants.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: P S
authors.initials: PS
authors.lastname: Rao
authors.forename: L
authors.initials: L
authors.lastname: Solymar
authors.forename: M K
authors.initials: MK
authors.lastname: Mardini
authors.forename: M E
authors.initials: ME
authors.lastname: Fawzy
authors.forename: G
authors.initials: G
authors.lastname: Guinn
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001021:Aortic Valve; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve; D012086:Reoperation; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants