Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis.
OBJECTIVE
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.
Yamak
B
B
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Iscan
Z
Z
Mavitas
B
B
Ulus
A T
AT
Katircioglu
S F
SF
Tasdemir
O
O
Bayazit
K
K
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001021:Aortic Valve / Q000601:surgery; D001241:Aspirin / Q000008:administration & dosage; D002648:Child; D004176:Dipyridamole / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004176:Dipyridamole; D001241:Aspirin