Thrombo-embolic complications of the cloth-covered Starr-Edwards prostheses No. 2300 aortic and No. 6300 mitral

Cleland, Jack; Molloy, P. J.

doi:10.1136/thx.28.1.41

Cited by 48 publications

(5 citation statements)

References 18 publications

(19 reference statements)

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“…There are a few other useful studies of coumarin not associated with antiplatelet drugs. The pa tients of the first of these studies ('Belfast') were monitored with Thrombotest, aiming at an INR of 2.1 (15% Thrombotest), which resulted in highly insufficient protection [34], The second study ('London') concerned patients checked with the well-standardized Manchester comparative reagent [Salsbury, pers. commun., 1981], the target range hav ing been 2-2.5 INR [29], Finally, recent ret- Table II rospective data from the Dutch thrombosis centres in Groningen [35] and Leiden are interesting, because both centres report ex cellent results and only the Groningen pa tients receive an oral anticoagulant com bined with dipyridamole.…”

Section: Intracardiac Thrombosismentioning

confidence: 99%

Optimal Therapeutic Anticoagulation

Loeliger¹

1985

Pathophysiol Haemos Thromb

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The relevant literature on the intensity of anticoagulation needed to prevent the development or growth of thrombi in patients at risk is reviewed. In case of elective surgery, prevention of venous thrombosis is easily attained with heparin or with coumarin alone, at levels of anticoagulation involving only a minor risk of bleeding complications. For posttraumatic prophylaxis, more intensive oral anticoagulation is required, similar to that for the management of active venous thrombosis, for which a combined heparin/coumarin regimen is proposed. A 90% reduction of the incidence of systemic emboli in patients with a high risk of developing intracardiac thrombosis requires high-intensity treatment with a target INR of 4. More intensive anticoagulation would be needed to obtain the same 90% protection in case of arterial (coronary) thrombosis. This is prohibited, however, by the rapidly increasing bleeding risk in cases with INR values > 5. With a target INR of 3.5 (sixty-Plus patients), the reinfarction rate will not be lowered by more than two thirds. Antiplatelet drugs given alone or in combination with anticoagulants have not been convincingly successful thus far in the prevention and treatment of thrombosis.

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Section: Intracardiac Thrombosismentioning

confidence: 99%

Optimal Therapeutic Anticoagulation

Loeliger¹

1985

Pathophysiol Haemos Thromb

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“…The intensity of treatment needed for prophylaxis of cardiac thromboembolism can be deduced from the small number of well controlled studies performed in patients with artificial heart valves [27][28][29][30][31][32][33][34]. A sche matic overview of the results of these studies is pre sented in figure 1.…”

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confidence: 99%

Laboratory Control, Optimal Therapeutic Ranges and Therapeutic Quality Control in Oral Anticoagulation

Ea¹

1985

Acta Haematol

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“…After this first 6-week period, anticoagulation with its attendant morbidity and mortality (Stanford et al, 1972;Cleland and Molloy, 1973;Vidne et al, 1973) was avoided in the large majority of patients (87%). It is possible that thrombus formation in the left atrium may have had a part to play in the sudden death of 2 patients comparatively soon after their oral anticoagulation had been discontinued.…”

Section: Discussionmentioning

confidence: 99%