In patients with mitral Starr-Edwards prostheses, non-anticoagulation was associated with a 40-fold higher incidence of embolism compared to adequate Coumadin anticoagulation.
Observational
Does adequate anticoagulation with warfarin and cardiac rhythm influence the incidence of embolization in patients with Starr-Edwards prostheses?
Adequate anticoagulation with warfarin is highly effective in preventing embolization after mitral valve replacement with Starr-Edwards prostheses, whereas non-anticoagulation and atrial fibrillation significantly increase risk.
Effect estimate: RR 40
The incidence of embolism following aortic and mitral valve replacement with Starr-Edwards prostheses has been analyzed and correlated with cardiac rhythm and anticoagulation. No embolism occurred in the aortic valve replacement group, regardless of use or nonuse of Coumadin. In the mitral group, the incidence of embolism during atrial fibrillation was approximately 1.7 times that during sinus rhythm. Coumadin prophylaxis was extremely effective. The incidence during non-anticoagulation was 40 times that during adequate anticoagulation, and seven times that during inadequate anticoagulation. Embolism occurred as late as 21 months after surgery, often shortly after termination of anticoagulation. Three of the four patients with emboli associated with bacterial endocarditis died. All nine patients with emboli not associated with infection survived, half without permanent sequelae.
Yeh et al. (1967) conducted an observational in Aortic and mitral valve replacement with Starr-Edwards prostheses. Coumadin vs. Non-anticoagulation or inadequate anticoagulation was evaluated on Incidence of embolism (RR 40). In patients with mitral Starr-Edwards prostheses, non-anticoagulation was associated with a 40-fold higher incidence of embolism compared to adequate Coumadin anticoagulation.