Key result
Fixed-dose anticoagulation for St. Jude AVR is linked to ~1.4% annual thromboembolism and similar hemorrhage rates.
Why the study?
The safety and efficacy of fixed dose oral anticoagulation without adjustment based on prothrombin time or cardiac rhythm in patients with the St. Jude Medical aortic valve prosthesis were uncertain.
Does fixed dose anticoagulation with warfarin plus antiplatelet therapy provide adequate safety and efficacy in patients undergoing primary aortic valve replacement with a St. Jude Medical mechanical prosthesis?
Population
865 patients undergoing primary aortic valve replacement with St. Jude Medical mechanical prosthesis
Comparison
Fixed dose Coumadin 2.5 mg/day plus antiplatelet therapy regardless of PT or cardiac rhythm
Design
Cohort study
Follow-up
Up to 10 years
Authors
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Low event rates with fixed dosing do not justify practice change; leaves open randomized validation versus INR-guided therapy.
Cohort (n=865)
Does fixed dose anticoagulation with warfarin plus antiplatelet therapy provide adequate safety and efficacy in patients undergoing primary aortic valve replacement with a St. Jude Medical mechanical prosthesis?
Fixed dose oral anticoagulation with warfarin plus antiplatelet therapy in patients with a St. Jude mechanical aortic valve does not increase thromboembolism rates but fails to reduce bleeding complications.
Katırcıoğlu et al. (1997) conducted a cohort in Primary aortic valve replacement (n=865). Fixed dose anticoagulation and antiaggregant therapy was evaluated on Valve-related complications. Fixed-dose oral anticoagulation after St. Jude aortic valve replacement resulted in a thromboembolism rate of 1.4% per patient-year and a hemorrhage rate of 1.58% per patient-year.
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