Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial

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 pa...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1985-11, Vol.72 (5), p.1059-1063
Main Authors: MOK, C. K, BOEY, J, WANG, R, CHAN, T. K, CHEUNG, K. L, LEE, P. K, CHOW, J, NG, R. P, TSE, T. F
Format: Article
Language:English
Subjects:
Adult
Aspirin - therapeutic use
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Clinical Trials as Topic
Dipyridamole - therapeutic use
Drug Combinations
Female
Heart Valve Prosthesis
Humans
Male
Medical sciences
Middle Aged
Pentoxifylline - therapeutic use
Pharmacology. Drug treatments
Postoperative Complications - drug therapy
Postoperative Complications - prevention & control
Prospective Studies
Random Allocation
Theobromine - analogs & derivatives
Thromboembolism - drug therapy
Thromboembolism - prevention & control
Warfarin - therapeutic use
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Summary: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.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.72.5.1059