Key result
Following mechanical mitral valve replacement, combined low-dose aspirin and warfarin (target INR 1.8-2.4) resulted in 0.02 thromboembolic events per patient-year compared to 0.08 with standard warfarin alone (p=0.362).
Why the study?
Warfarin is recommended after mechanical valve replacement, but whether adding aspirin further reduces thromboembolic events safely remained to be evaluated.
Does combined low dose aspirin (75mg) and warfarin (target INR 1.8-2.4) reduce thromboembolic events and bleeding compared to conventional warfarin alone (target INR 2.5-3.5) in adult patients following mechanical mitral valve replacement?
Cohort (n=99)
No
Does combined low dose aspirin (75mg) and warfarin (target INR 1.8-2.4) reduce thromboembolic events and bleeding compared to conventional warfarin alone (target INR 2.5-3.5) in adult patients following mechanical mitral valve replacement?
A combination of low-dose aspirin and lower-intensity warfarin (target INR 1.8-2.4) may provide satisfactory outcomes regarding thrombosis, embolism, and bleeding without increasing mortality after mechanical mitral valve replacement.
Introduction: Warfarin is recommended following mechanical valve replacement to prevent thromboembolic complications. A combination of warfarin and aspirin may further reduce thromboembolic events in these patients. This study was designed to evaluate safety and efficacy of combined low dose aspirin and warfarin therapy following mechanical mitral valve replacement. Materials and Methods: Purposively selected 99 patients who underwent mechanical mitral valve replacement were divided into two groups. Patients of Group A (n=50) received combined low dose aspirin (75mg) and warfarin. Patients of Group B (n=49) received conventional dose of warfarin alone. International normalized ratio (INR) was targeted 1.8-2.4 for group A Patients and 2.5-3.5 for group B Patients. Post-operatively INR, thromboembolic events, anti-coagulation related haemorrhage and other morbidity and mortality were registered in both groups. Result: Patients were followed up postoperatively for 9 months. The mean dose of warfarin in group A and group B was 4.36 ± 0.31 mg and 5.57±0.52 mg respectively (p<0.001). The overall mean INR of two groups of patients were statistically different (P<0.001) with low INR in group A (2.19±0.13) patients compared to group B (3.03±0.31). The thromboembolic events in group A (0.02/patient year) were lower than those in group B (0.08/Patient year). There was no statistically significant (p=0.362) difference in bleeding episodes between two groups but data indicate proportion of minor bleeding manifestations were higher in patients treated with warfarin plus aspirin group. Conclusion: Following mechanical mitral valve replacement, a combination of aspirin (75mg) and low dose warfarin with an aim to maintain INR between 1.8 and 2.4 (lower than recommended 2.5-3.5) may provide satisfactory outcomes in term of thrombosis, embolism and bleeding without increase in mortality. Bangladesh Heart Journal 2021; 36(1): 24-31
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Hossain et al. (2021) conducted a cohort in Mechanical mitral valve replacement for mitral valve disease (n=99). Aspirin and Warfarin vs. Warfarin alone (target INR 2.5-3.5) was evaluated on Thromboembolic events (per patient-year) (p=0.362). Following mechanical mitral valve replacement, combined low-dose aspirin and warfarin (target INR 1.8-2.4) resulted in 0.02 thromboembolic events per patient-year compared to 0.08 with standard warfarin alone (p=0.362).
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