Assessment of anticoagulant complications in patients after cardiac valve replacement

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Abstract

We compared in a previous study 6 the efficacy and complications of anticoagulation in patients after cardiac valve replacement who were blindy randomized into two groups, both taking aspirin 300 mg plus dipyridamole 15 mg, an the oral anticoagulant. An INR (International Normalized Ratio) of 2-3 was assigned to group A and 3-4.5 to group B. The frequency of thromboembolism was equal in both groups and a statistical reduction in bleeding complications was observed in the less intensity group treated (p = 0.02). We concluded that an INR of 2-3 is safer than a INR of 3-4.5 when oral anticoagulant therapy is used conjointly with platelet function inhibiting drugs. Because of that, we decided to continuous this regimen in 59 patients during 1320 months as a routinary therapy (23.15 months/patient). One thromboembolism occurred in this follow-up study (a rate of 0.9/100 patient-year) and two patients bled (a rate of 2.7/100 patient/year). There were less complications than the former work but the difference was not statistically significant. We conclude that a routine therapy with a low anticoagulant intensity (INR 2-3) plus platelet inhibitors drugs confers good protection from thromboembolism with minimal bleeding accidents