Standard versus low-level anticoagulation combined to low-dose dipyridamole after mitral valve replacement

Hassouna, Ahmed; Allam, Hemat; Awad, Ahmed K.; Hassaballah, F

doi:10.1016/s0967-2109(00)00069-7

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Failure to describe allocation concealment across all aforementioned studies has resulted in a high risk of selection bias throughout the literature. In some cases, the trials were non‐randomized, with clinicians permitted to determine the allocation of patients to dual therapy or anticoagulant monotherapy 39,43 …”

Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

“…In some cases, the trials were non-randomized, with clinicians permitted to determine the allocation of patients to dual therapy or anticoagulant monotherapy. 39,43 In addition, most studies used relatively small sample sizes, commonly with under 200 patients per treatment arm, making the implication of any findings difficult to establish. In particular, similar rates of hemorrhage with and without aspirin in some trials may reflect the research being underpowered to find differences, leading to an underestimation of the risks associated with dual therapy.…”

Section: Through Open Access T a B L E 1 Summary Of Guidelines For Inmentioning

confidence: 99%

“…Meschengieser et al 41 and Pengo et al 42 both reported that low‐intensity VKA anticoagulation combined with low‐dose aspirin provided similar antithrombotic protection as high‐intensity VKA monotherapy, without increasing hemorrhagic risk or mortality. Hassouna et al 43 found that using dipyridamole instead as the antiplatelet actually reduced the incidence of thromboembolism whilst still avoiding an increase in hemorrhage or mortality. Furthermore, two studies which reported particularly low bleeding rates in anticoagulated groups, both with and without aspirin, used relatively low INR targets (1.8–2.5) 35,36 .…”

Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

“…Nonetheless, a complete dismissal of the potential role of DOACs in mechanical valve patients due to poor outcomes in just one study may be premature. It has been posited that RE‐ALIGN's targeted trough level of 50 ng/ml when dosing dabigatran may have been too low to adequately evaluate its antithrombotic potential, 47,48 considering the much higher concentrations used in more successful animal studies 41‐43 . Plasma levels of dabigatran were especially low in the early weeks post‐surgery for many patients in RE‐ALIGN, increasing the risk of early clot formation, with a possibly delayed manifestation.…”

Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

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Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

et al. 2020

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Background: The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature. Antithrombotic therapies are used after heart valve intervention to reduce the rates of thromboembolic events, therefore improving patient outcomes. Different interventions may require different therapeutic regimens to achieve the most efficacious clinical outcome for patients. Methods and Discussion: This review aims to summarize and critique the available literature concerning therapeutic agents used for bioprosthetic and mechanical valves as well as for valve repair, so as to assist clinicians and researchers in making decisions with regard to their patients and research endeavors.

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Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

Section: Through Open Access T a B L E 1 Summary Of Guidelines For Inmentioning

confidence: 99%

Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

Section: Antithrombotic Therapies In Mechanical Valve Replacementmentioning

confidence: 99%

See 2 more Smart Citations

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

et al. 2020

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“…Monthly checks of prothrombin were recommended, and asymptomatic patients with a too-low or a too-high INR (< 1.3 or > 5) were briefly hospitalized for INR control. 43 Hirsh and Fuster 44 have recommended a lower intensity of anticoagulation to a target INR of 2.5-3.5 for patients with mechanical prostheses. Different brain-to-core temperatures have been shown with different anaesthetics during CPB.…”

Section: Strategies Of Managementmentioning

confidence: 99%

Subsequent intracranial haemorrhage following open heart surgery

Yuan

Guo

2001

Annals of the College of Surgeons of Hong Kong

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Intracranial haemorrhage (ICH) is an uncommon but lethal complication of open heart surgery. The aim of the present paper is to analyse studies of ICH subsequent to open heart surgery and further to discuss the risk factors and strategies. Articles were obtained from Index Medicus/MEDLINE database of the National Library of Medicine USA from 1966 to present, and the Chinese Biomedical Literature Database (CBMDISC) of the Institute of Medical Information of Chinese Academy of Medical Sciences from January 1982 to December 2000. Search terms included cardiopulmonary bypass, cardioplegia, neurosurgery, craniotomy, sphenotresia, ICH, intracranial haematoma, haemorrhagic stroke/infarct and craniocerebral injury. Information obtained from the cited literature helped complete the collection of the documents. In total 35 reports covering 179 cases are reviewed. Of the 182 ICHs of 179 patients after open heart surgery, intracerebral haemorrhage was the most frequent (41.21%), subdural haematoma was the second (22.53%) and epidural haematoma was the third (12.64%). Of the 77 sites of ICHs that can be traced, the frontal region was involved the most (23.34%) and the parietal, occipital and temporoparietal regions second (each was 12.99%). It occurred most often on the right (55.84%), more often on the left (31.77%), and the least often on bilateral (12.99%) sides of the brain. Haemorrhage in intracerebral was most common (40.66%), sudural the second (22.53%), then epidural (12.64%) and subarachnoid (3.85%) and the least common in multiple sites. Sixty‐eight (37.36%) of the patients were treated by craniotomy for haematoma evacuation, 30 (16.48%) by conservative treatment, 27 (14.84%) were not treated in time and died, and the other 57 (31.32%) treatment methods are unknown. Forty‐two patients (23.08%) survived, one of whom (0.55%) was in a vegatative state, 103 (56.59%) died and 37 (20.33%) have unknown outcomes. ICH following open heart surgery is rare but risky and always life threatening. Any factors leading to cerebrovascular injury or fluid shifts with fluctuations in cerebral volume during pre‐, intra‐ or postoperation of open heart surgery may cause ICH. Computed tomography scan optimizes the detection of ICH. Miscellaneous prophylactic approaches are mandatory for patients vulnerable to ICH following open heart surgery. Therapeutic approaches as either antibiotics or early operations should be determined on a substantial basis of prosthetic endocarditis patients with ICHs.

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Antiplatelet and anticoagulation for patients with prosthetic heart valves

Little¹,

Massel²

2003

Cochrane Database of Systematic Reviews

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Standard versus low-level anticoagulation combined to low-dose dipyridamole after mitral valve replacement

Cited by 10 publications

References 17 publications

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

Subsequent intracranial haemorrhage following open heart surgery

Antiplatelet and anticoagulation for patients with prosthetic heart valves

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