| Efficacy and safety of combined anticoagulant and antiplatelet therapy versus anticoagulant monotherapy after mechanical heart-valve replacement: a metaanalysis. | |
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MedLine Citation:
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PMID: 7661074 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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J C Cappelleri; L D Fiore; M T Brophy; D Deykin; J Lau |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American heart journal Volume: 130 ISSN: 0002-8703 ISO Abbreviation: Am. Heart J. Publication Date: 1995 Sep |
Date Detail:
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Created Date: 1995-10-04 Completed Date: 1995-10-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 547-52 Citation Subset: AIM; IM |
Affiliation:
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New England Medical Center, Boston, MA 02111, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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HS-07782/HS/AHRQ HHS |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Platelet Aggregation Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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