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(Circulation. 1973;48:III-48.)
© 1973 American Heart Association, Inc.

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Evaluation of Anticoagulant Therapy in Cloth-Covered Prosthetic Valves

O. WAYNE ISOM M.D.¹; C. DAVID WILLIAMS M.D.¹; EMILY A. FALK PH.D.¹; FRANK C. SPENCER M.D.¹; EPHRAIM GLASSMAN M.D.¹

¹ From the Departments of Surgery and Medicine, New York University Medical Center, 550 First Avenue, New York, New York 10016.

Over a period of four years, a series of 303 patients had prosthetic valve replacement with the Starr-Edwards cloth-covered metallic ball prosthesis. There were 135 aortic replacements, 105 mitral, 42 combined mitral and aortic, and 21 combined mitral and tricuspid. The frequency of thromboembolism and hemorrhage was studied in patients receiving warfarin sodium (Coumadin) and in those not receiving warfarin.

No thromboemboli occurred during 2,052 patient-months of observation in patients with aortic prostheses who were receiving warfarin, but 10 episodes of hemorrhage occurred. By comparison, after anticoagulants were discontinued, there was 1 episode of thromboembolism during 786 months of patient observation.

Among patients with mitral prostheses who were receiving warfarin, 3 episodes of thromboembolism occurred in 2,081 patient-months of observation, during which 5 hemorrhagic episodes also occurred. By comparison, after warfarin was discontinued, there were 3 episodes of thromboembolism during 402 months.

In patients with mitral and aortic prostheses who were receiving warfarin, 1 episode of thromboembolism occurred in 670 patient-months, and no episodes of hemorrhage. Without anticoagulation, 2 episodes of thromboembolism occurred in 130 patient-months.

In patients with mitral and tricuspid prostheses who were receiving warfarin, there were no episodes of thromboembolism during 186 patient-months, but there was 1 episode of hemorrhage. Without anticoagulation, however, there were 3 episodes of thromboembolism during 32 months of patient observation.

Key Words: Thromboembolism • Hemorrhage • Warfarin sodium • Aspirin