Document Detail


Efficacy and safety of combined anticoagulant and antiplatelet therapy versus anticoagulant monotherapy after mechanical heart-valve replacement: a metaanalysis.
MedLine Citation:
PMID:  7661074     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We performed a metaanalysis of five randomized controlled trials to compare the efficacy and safety of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulants alone after prosthetic heart-valve replacement. The combined regimen reduced embolism and overall mortality by approximately 67% (pooled odds ratio [OR] 0.33; 95% confidence interval [CI] 0.16 to 0.69; p = 0.0032) and 40% (OR 0.60; 95% CI 0.32 to 1.12; p = 0.11), respectively, but increased the risk of hemorrhage by approximately 65% (OR 1.65; 95% CI 1.15 to 2.39; p = 0.0069) and of major gastrointestinal hemorrhage by approximately 250% (OR 3.47; 95% CI 1.43 to 8.40; p = 0.0058). It is estimated that for every 1.6 patients who had their stroke prevented by combination therapy, there was an excess of one major gastrointestinal bleed. This metaanalysis suggests that the benefits derived from the enhanced antithrombotic potential of combined therapy outweigh the toxic effects resulting from the enhanced anticoagulant potential of this regimen.
Authors:
J C Cappelleri; L D Fiore; M T Brophy; D Deykin; J Lau
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  130     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1995 Sep 
Date Detail:
Created Date:  1995-10-04     Completed Date:  1995-10-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  547-52     Citation Subset:  AIM; IM    
Affiliation:
New England Medical Center, Boston, MA 02111, USA.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Anticoagulants / adverse effects,  therapeutic use*
Confidence Intervals
Drug Therapy, Combination
Heart Valve Prosthesis*
Humans
Odds Ratio
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Postoperative Care*
Randomized Controlled Trials as Topic
Risk Assessment
Safety
Sensitivity and Specificity
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HS-07782/HS/AHRQ HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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