Key result
Adding aspirin to VKAs cuts thromboembolic events ~53% in mechanical heart valves.
Why the study?
The efficacy and safety of combined VKA and aspirin therapy compared to VKA monotherapy in patients after mechanical valve replacement needed systematic evaluation.
Does adding aspirin to VKA therapy reduce thromboembolic events and mortality in patients with mechanical heart valves?
Meta-Analysis (n=4,082)
Does adding aspirin to VKA therapy reduce thromboembolic events and mortality in patients with mechanical heart valves?
Odds Ratio: 0.47 (95% CI 0.33–0.67)
Absolute Event Rate: 2.4% vs 5.1%
p-value: p=<0.0001
Combining aspirin with vitamin K antagonists significantly decreases the risk of systemic embolism and mortality in patients with mechanical heart valves without a statistically significant increase in major bleeding.
Supports aspirin addition to VKA in mechanical valves; reinforces RCT evidence for lower thromboembolism and mortality.
Aim. To conduct a systematic review and meta-analysis of the efficacy and safety of combined oral anticoagulant therapy with vitamin K antagonists (VKA) and antiplatelet therapy with aspirin compared with VKA monotherapy in patients after mechanical valve replacement. Material and methods . We searched the PubMed, Google Scholar databases for studies comparing the risk of thromboembolic events, major bleeding, and mortality in VKA monotherapy versus combined aspirin and VKA therapy in patients with mechanical valve replacement. Results. Eight randomized clinical trials were selected for this systematic review and meta-analysis. In total, 4082 patients were included in the analysis (mean age, 50,8 years, men — 2484 (60,9%)). A meta-analysis showed that the addition of aspirin to VKA, compared with VKA monotherapy, significantly reduced the incidence of thromboembolic events (odds ratio (OR) 0,47; 95% confidence interval (CI): 0,33-0,67; p<0,0001) and mortality (OR 0,58; 95% CI: 0,38-0,88; p=0,01). The risk of major bleeding in the aspirin plus VKA group compared with VKA monotherapy tended to increase, without reaching a significant difference (OR 1,41; 95% CI: 0,99-2,01; p=0,06). Conclusion. The addition of aspirin to VKA, compared with VKA monotherapy, reduces the risk of systemic embolism and death in patients after mechanical valve replacement. At the same time, the risk of major bleeding did not differ between the groups.
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Голухова et al. (2022) conducted a meta-analysis in Mechanical heart valve replacement (n=4,082). Vitamin K Antagonists (VKA) plus aspirin vs. Vitamin K Antagonists (VKA) monotherapy was evaluated on Thromboembolic events (OR 0.47, 95% CI 0.33-0.67, p=<0.0001). The addition of aspirin to vitamin K antagonists significantly reduced thromboembolic events (OR 0.47) and mortality (OR 0.58) compared to VKA monotherapy in patients with mechanical heart valves.
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