HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pouleur, H. Articles by Buyse, M. Search for Related Content PubMed PubMed Citation Articles by Pouleur, H. Articles by Buyse, M.

J Thorac Cardiovasc Surg 1995;110:463-472
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

EFFECTS OF DIPYRIDAMOLE IN COMBINATION WITH ANTICOAGULANT THERAPY ON SURVIVAL AND THROMBOEMBOLIC EVENTS IN PATIENTS WITH PROSTHETIC HEART VALVESA meta-analysis of the randomized trials

Brussels, Belgium

Received for publication June 16, 1994. Accepted for publication Nov. 15, 1994. Address for reprints: Hubert Pouleur, MD, University of Louvain, avenue Hippocrate 55/5560, B-1200 Brussels, Belgium.

Abstract

The addition of dipyridamole, an antiplatelet agent, to conventional anticoagulant regimens has been shown to reduce the frequency of embolization after valve replacement with a mechanical prosthesis. The purpose of this meta-analysis was to reevaluate the benefit of dipyridamole by analyzing the evidence from all randomized clinical trials. Summary data were extracted from the application to the Food and Drug Administration. Six randomized clinical trials had accrued 1141 patients, of whom 582 received anticoagulant therapy alone and 559 received additional dipyridamole at dosages ranging from 225 to 400 mg per day. The events analyzed were all thromboembolic events, both fatal and nonfatal; hemorrhagic events, both fatal and nonfatal; and the overall mortality. The combination of dipyridamole with anticoagulants reduced the risk of thromboembolic events (fatal or nonfatal) by 56% when compared with the use of anticoagulants alone (p = 0.0001). The risk reduction was seen in fatal and in nonfatal thromboembolic events (risk reduction for fatal events, 64%, p = 0.008; for nonfatal events, 50%, p = 0.005). The overall mortality rate was also significantly reduced by 40% in the group receiving dipyridamole (p = 0.013). There was no difference between treatment groups with respect to hemorrhagic events (risk reduction, -1%, p = 0.94). This meta-analysis supports the use of dipyridamole in this setting and warrants further trials with new antiplatelet agents. (J THORAC CARDIOVASC SURG 1995;110:463-72)

This article has been cited by other articles:

				S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]

				E. G. Butchart, C. Gohlke-Barwolf, M. J. Antunes, P. Tornos, R. De Caterina, B. Cormier, B. Prendergast, B. Iung, H. Bjornstad, C. Leport, et al. Recommendations for the management of patients after heart valve surgery Eur. Heart J., November 2, 2005; 26(22): 2463 - 2471. [Abstract] [Full Text] [PDF]

				D. V. Nagarajan, P. S. Lewis, P. Botha, and J. Dunning Is addition of anti-platelet therapy to warfarin beneficial to patients with prosthetic heart valves? Interactive CardioVascular and Thoracic Surgery, September 1, 2004; 3(3): 450 - 455. [Abstract] [Full Text] [PDF]

				M. N. Levine, G. Raskob, R. J. Beyth, C. Kearon, and S. Schulman Hemorrhagic Complications of Anticoagulant Treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 287S - 310S. [Abstract] [Full Text] [PDF]

				M. Perleth and R. Busse Health technology assessment of oral anticoagulation following heart valve replacement Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q60 - Q64. [Abstract] [PDF]

				D. Massel and S. H. Little Risks and benefits of adding anti-platelet therapy to warfarin among patients with prosthetic heart valves: a meta-analysis J. Am. Coll. Cardiol., February 1, 2001; 37(2): 569 - 578. [Abstract] [Full Text] [PDF]

				P. D. Stein, J. S. Alpert, H. I. Bussey, J. E. Dalen, and A. G.G. Turpie Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves Chest, January 1, 2001; 119 (2009): 220S - 227S. [Full Text] [PDF]

				P Kvidal, R Bergstrom, T Malm, and E Stahle Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis Eur. Heart J., July 1, 2000; 21(13): 1099 - 1111. [Abstract] [PDF]

				M. Verstraete, C. R. M. Prentice, M. Samama, and R. Verhaeghe A European View on the North American Fifth Consensus on Antithrombotic Therapy Chest, June 1, 2000; 117(6): 1755 - 1770. [Abstract] [Full Text] [PDF]

				J. L. Wilterdink and J. D. Easton Dipyridamole Plus Aspirin in Cerebrovascular Disease Arch Neurol, September 1, 1999; 56(9): 1087 - 1092. [Abstract] [Full Text] [PDF]