Circulation, Vol 72, 1059-1063, Copyright © 1985 by American Heart Association
CK Mok, J Boey, R Wang, TK Chan, KL Cheung, PK Lee, J Chow, RP Ng and TF Tse
In a prospective, randomized, parallel study, two regimens of platelet-
suppressant therapy (PST)--dipyridamole-aspirin and pentoxifylline-
aspirin--were compared with standard oral anticoagulation with warfarin in
the prevention of prosthetic heart valve thromboembolism. In the entire
group of 254 patients followed for 395.6 patient-years, the thromboembolic
rate was significantly less in the warfarin group (warfarin vs
dipyridamole-aspirin, p less than .005; warfarin vs pentoxifylline-aspirin,
p less than .05). Subgroup analysis disclosed that, in patients with
isolated mitral valve replacement, warfarin was superior to both of the
PSTs with respect to the prevention of thromboembolism (warfarin vs
dipyridamole-aspirin, p = .005; warfarin vs pentoxifylline-aspirin, p less
than .05). Furthermore, a significant number of our patients could not
tolerate the antiplatelet agents. However, in the rare situation in which
repeated significant bleeding occurs despite careful adjustment of the
dosage of warfarin, PST may be an acceptable alternate method of
thromboembolism prophylaxis.
ARTICLES
Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial
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