Document Detail

An overview of anticoagulants, antiplatelet agents, and the combination in patients with mechanical heart valves.
MedLine Citation:
PMID:  15222274     Owner:  NLM     Status:  MEDLINE    
Currently, and for the near future, well-managed warfarin appears to be the most effective method to prevent thromboembolism and bleeding in patients with mechanical heart valves. These patients, when in an anticoagulation management service, have 50-90% fewer complications than patients not managed in this way. Further, the complication rate in such settings approximates that in patients with bioprosthetic, tissue valves not receiving anticoagulation. Oral direct thrombin inhibitors are safe and effective in patients with atrial fibrillation, but this is not proven in those with prosthetic heart valves. The idea of using a combination of different antiplatelet agents is attractive on a theoretical basis, but the available data are limited and do not support this approach. Combined aspirin (or another antiplatelet agent) and warfarin has been recommended, but close scrutiny of this combination suggests that it causes more bleeding and may offer no more protection than well-managed warfarin therapy. Recently, interest has been shown in the significance of high-intensity transient signals (HITS), which may represent gaseous or microemboli, and whether therapy to reduce HITS might influence the development of neurological symptoms. However, present data related to HITS are too limited and conflicting to make any firm conclusions.
Henry I Bussey
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  13     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-06-29     Completed Date:  2004-10-19     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  319-24     Citation Subset:  IM    
College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.
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MeSH Terms
Anticoagulants / adverse effects,  therapeutic use*
Drug Therapy, Combination
Heart Valve Prosthesis / adverse effects*
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Thromboembolism / etiology,  prevention & control*
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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