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CLINICAL STUDIES

Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the st. jude medical prosthesis

A clinical and transesophageal echocardiographic study

^a Service d’Echocardiographie PR Roudaut, Cardiologic Hospital Haut-Leveque, 33600 Bordeaux-Pessac, France

Manuscript received March 6, 1999; revised manuscript received October 5, 1999, accepted November 17, 1999.

Reprint requests and correspondence: Dr. Patrick Laffort, Service de Cardiologie Pr Roudaut, Hôpital Haut-Leveque, Avenue de Magellan, 33604 Pessac, France.
lfr.Cardio{at}bordeaux.inserm.fr

OBJECTIVES

The aim of the study was to test the value of low dose aspirin associated with standard oral anticoagulants (OAC) after mechanical mitral valve replacement (MMRV) to reduce strands, thrombi and thromboembolic events.

BACKGROUND

Strands and thrombi are thought to increase the risk of embolic events after MMVR, particularly in the immediate postoperative period.

METHODS

Two hundred twenty-nine patients were prospectively recruited: 109 patients (group A+) were randomly assigned to aspirin (200 mg per day) with OAC and 120 patients (group A–) to OAC alone (international normalized ratio 2.5 to 3.5). All patients were subjected to multiplane transesophageal echocardiography at nine days and five months and were followed up for one year.

RESULTS

At nine days and five months, there was a high and comparable incidence of strands in the two groups (group A+: 44%, 58%; group A–: 49%, 63%). However, the incidence of nonobstructive periprosthetic valve thrombi was significantly lower in group A+ at 9 days: 5% versus 13%, p = 0.03. Total thromboembolic events were reduced in group A+ (9% vs. 25%, p = 0.004) although there was an increased incidence of gastrointestinal hemorrhage (7% vs. 0%). Overall mortality was 9% in group A+ and 4% in group A–. Valve-related events were similar in both groups. Early thrombi, but not strands, were associated with higher morbidity, especially thromboembolic events (30% vs. 13%, p = 0.003).

CONCLUSIONS

One year after MMVR, the association of aspirin with OAC reduced thrombi and thromboembolic events, but not morbidity, due to an increase in hemorrhagic complications.

Abbreviations and Acronyms   CAD = coronary artery disease   GIB = gastrointestinal bleeding   INR = international normalized ratio   MMVR = mechanical mitral valve replacement   MVR = mitral valve replacement   OAC = oral anticoagulant   RR = relative risk   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography

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