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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 427-431, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Altman, J Rouvier, E Gurfinkel, O D'Ortencio, R Manzanel, L de La Fuente and RG Favaloro
After cardiac valve replacement patients were blindly randomized into two
groups, both receiving aspirin (330 mg) and dipyridamole (75 mg) twice
daily and the oral anticoagulant acenocoumarol (Sintrom). An international
normalized ratio of 2.0 to 2.99 was assigned to group A and 3.0 to 4.5 to
group B; both groups were subsequently analyzed for thromboembolic and
hemorrhagic complications. Final evaluation included 51 and 48 patients,
respectively. The follow-up was 626 months for group A (12.3
months/patient) and 486 months for group B (10.1 months/patient). The
frequency of thromboembolism was equal in both groups: one transient
ischemic attack in group A (a rate of 1.92/100 patient-years) and two
transient ischemic attacks in group B (a rate of 4.94/100 patient-years).
There was, however, a statistical difference in bleeding complications
between the two groups (p less than 0.02). Two patients bled in group A, a
rate of 3.9% (3.8/100 patient-years), which represents an incidence of one
episode each 25.6 years of treatment; 10 patients bled in group B, a rate
of 20.8% (24.7/100 patient-years) representing an incidence of one episode
each 4 years of treatment. We conclude that an international normalized
ratio of 2 to 3 is safer than a ratio of 3 to 4.5 and confers good
protection from thromboembolism when oral anticoagulant therapy is used
conjointly with platelet function-inhibiting drugs in patients with
mechanical substitute heart valves.
ARTICLES
Comparison of two levels of anticoagulant therapy in patients with substitute heart valves
Fundacion Favaloro and Centro de Estudios Medicos y Bioquimicos Buenos Aires, Argentina.
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C. G. Fondevila, S. S. Meschengieser, M. T. Santarelli, M. T. F. Aixala, and M. A. Lazzari Prevalence of Anemia and Occult Blood Losses in the Long-Term Follow-Up of Cardiac Mechanic Valve Patients Treated with a Combination of Low-Dose Aspirin Plus Low-Intensity Acenocoumarin Clinical and Applied Thrombosis/Hemostasis, January 1, 1997; 3(1): 36 - 39. [Abstract] [PDF]
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T.-M. Lee, N.-K. Chou, S.-F. Su, Y.-J. Lin, M.-F. Chen, C.-S. Liau, Y.-T. Lee, and S.-H. Chu Left Atrial Spontaneous Echo Contrast in Asymptomatic Patients With a Mechanical Valve Prosthesis Ann. Thorac. Surg., December 1, 1996; 62(6): 1790 - 1795. [Abstract] [Full Text]
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J. Acar, B. Iung, J. P. Boissel, M. M. Samama, P. L. Michel, J. P. Teppe, J. C. Pony, H. Le Breton, D. Thomas, R. Isnard, et al. AREVA: Multicenter Randomized Comparison of Low-Dose Versus Standard-Dose Anticoagulation in Patients With Mechanical Prosthetic Heart Valves Circulation, November 1, 1996; 94(9): 2107 - 2112. [Abstract] [Full Text]
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R. Altman, J. Rouvier, E. Gurfinkel, A. Scazziota, and A. G.G. Turpie Comparison of High-Dose With Low-Dose Aspirin in Patients With Mechanical Heart Valve Replacement Treated With Oral Anticoagulant Circulation, November 1, 1996; 94(9): 2113 - 2116. [Abstract] [Full Text]
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 F.R. Rosendaal The Scylla and Charybdis of Oral Anticoagulant Treatment N. Engl. J. Med., August 22, 1996; 335(8): 587 - 589. [Full Text]
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J. F. Nistal, A. Hurle, J. M. Revuelta, and M. Gandarillas CLINICAL EXPERIENCE WITH THE CARBOMEDICS VALVE: EARLY RESULTS WITH A NEW BILEAFLET MECHANICAL PROSTHESIS J. Thorac. Cardiovasc. Surg., July 1, 1996; 112(1): 59 - 68. [Abstract] [Full Text]
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J. Hirsh and J. Hoak Management of Deep Vein Thrombosis and Pulmonary Embolism : A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association Circulation, June 15, 1996; 93(12): 2212 - 2245. [Full Text]
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H. Pouleur and M. Buyse EFFECTS OF DIPYRIDAMOLE IN COMBINATION WITH ANTICOAGULANT THERAPY ON SURVIVAL AND THROMBOEMBOLIC EVENTS IN PATIENTS WITH PROSTHETIC HEART VALVESA meta-analysis of the randomized trials J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 463 - 472. [Abstract] [Full Text]
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 R. G. Hart, B. S. Boop, and D. C. Anderson Oral Anticoagulants and Intracranial Hemorrhage : Facts and Hypotheses Stroke, August 1, 1995; 26(8): 1471 - 1477. [Abstract] [Full Text]
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S.C. Cannegieter, F.R. Rosendaal, A.R. Wintzen, F.J.M. van der Meer, J.P. Vandenbroucke, and E. Briet Optimal Oral Anticoagulant Therapy in Patients with Mechanical Heart Valves N. Engl. J. Med., July 6, 1995; 333(1): 11 - 17. [Abstract] [Full Text] [PDF]
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S. D. Fihn Aiming for Safe Anticoagulation N. Engl. J. Med., July 6, 1995; 333(1): 54 - 55. [Full Text]
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M. Sturzenegger, J. H. Beer, and F. Rihs Monitoring Combined Antithrombotic Treatments in Patients With Prosthetic Heart Valves Using Transcranial Doppler and Coagulation Markers Stroke, January 1, 1995; 26(1): 63 - 69. [Abstract] [Full Text]
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D. Horstkotte, H. D. Schulte, W. Bircks, and B. E. Strauer Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude Medical prosthesis J. Thorac. Cardiovasc. Surg., April 1, 1994; 107(4): 1136 - 1145. [Abstract] [Full Text]
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M. H. Eckman, H. J. Levine, and S. G. Pauker Effect of Laboratory Variation in the Prothrombin-Time Ratio on the Results of Oral Anticoagulant Therapy N. Engl. J. Med., September 2, 1993; 329(10): 696 - 702. [Abstract] [Full Text]
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A. Turpie, M. Gent, A. Laupacis, Y. Latour, J. Gunstensen, F. Basile, M. Klimek, and J. Hirsh A Comparison of Aspirin with Placebo in Patients Treated with Warfarin after Heart-Valve Replacement N. Engl. J. Med., August 19, 1993; 329(8): 524 - 529. [Abstract] [Full Text]
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