Key result
Low-dose aspirin plus warfarin cuts prosthetic valve mortality with an NNT of ~19 but increases bleeding.
Why the study?
Does the addition of low dose aspirin (80-100 mg daily) to warfarin reduce the incidence of thromboembolic complications in patients with prosthetic heart valves?
Systematic Review
Does the addition of low dose aspirin (80-100 mg daily) to warfarin reduce the incidence of thromboembolic complications in patients with prosthetic heart valves?
Adding low-dose aspirin to warfarin in patients with prosthetic heart valves reduces long-term mortality and thromboembolism, though it increases bleeding risk.
Answers are grounded in this paper and cite their sources.
Supports adding low-dose aspirin to warfarin in prosthetic valves despite bleeding risk; confirms mortality and thromboembolic benefits in Level 1 evidence.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether addition of anti-platelet therapy to warfarin reduced the incidence of thromboembolic complications in patients with prosthetic heart valves. Altogether 253 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that low dose aspirin (80-100 mg daily) in addition to warfarin in patients with prosthetic heart valves reduces all cause long term mortality (NNT=19), with significant reductions in thromboembolism but an increase in bleeding.
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Darbhamulla V. Nagarajan (2004) conducted a systematic review in prosthetic heart valves. low dose aspirin in addition to warfarin vs. warfarin alone was evaluated on all cause long term mortality (NNT=19). Low dose aspirin (80-100 mg daily) added to warfarin in patients with prosthetic heart valves reduces all-cause long-term mortality (NNT=19) and thromboembolism, but increases bleeding.
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