Document Detail

Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the St. Jude medical prosthesis: a clinical and transesophageal echocardiographic study.
MedLine Citation:
PMID:  10716478     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of the study was to test the value of low dose aspirin associated with standard oral anticoagulants (OAC) after mechanical mitral valve replacement (MMRV) to reduce strands, thrombi and thromboembolic events. BACKGROUND: Strands and thrombi are thought to increase the risk of embolic events after MMVR, particularly in the immediate postoperative period. METHODS: Two hundred twenty-nine patients were prospectively recruited: 109 patients (group A+) were randomly assigned to aspirin (200 mg per day) with OAC and 120 patients (group A-) to OAC alone (international normalized ratio 2.5 to 3.5). All patients were subjected to multiplane transesophageal echocardiography at nine days and five months and were followed up for one year. RESULTS: At nine days and five months, there was a high and comparable incidence of strands in the two groups (group A+: 44%, 58%; group A-: 49%, 63%). However, the incidence of nonobstructive periprosthetic valve thrombi was significantly lower in group A+ at 9 days: 5% versus 13%, p = 0.03. Total thromboembolic events were reduced in group A+ (9% vs. 25%, p = 0.004) although there was an increased incidence of gastrointestinal hemorrhage (7% vs. 0%). Overall mortality was 9% in group A+ and 4% in group A-. Valve-related events were similar in both groups. Early thrombi, but not strands, were associated with higher morbidity, especially thromboembolic events (30% vs. 13%, p = 0.003). CONCLUSIONS: One year after MMVR, the association of aspirin with OAC reduced thrombi and thromboembolic events, but not morbidity, due to an increase in hemorrhagic complications.
P Laffort; R Roudaut; X Roques; S Lafitte; C Deville; J Bonnet; E Baudet
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  35     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2000 Mar 
Date Detail:
Created Date:  2000-03-24     Completed Date:  2000-03-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  739-46     Citation Subset:  AIM; IM    
Service d'Echocardiographie PR Roudaut, Cardiologic Hospital Haut-Leveque, Bordeaux-Pessac, France.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage*
Aspirin / administration & dosage*
Drug Therapy, Combination
Echocardiography, Transesophageal*
Follow-Up Studies
Heart Valve Diseases / surgery,  ultrasonography
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation*
Middle Aged
Mitral Valve* / surgery,  ultrasonography
Platelet Aggregation Inhibitors / administration & dosage*
Prospective Studies
Risk Factors
Survival Rate
Thromboembolism / epidemiology,  prevention & control*,  ultrasonography
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

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