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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 553-561, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RM Sade, FA Crawford Jr, DA Fyfe and MR Stroud
We have previously published evidence that children with St. Jude Medical
prostheses on the left side of the heart may not require anticoagulation.
Between March 1979 and September 1986, we followed up 48 patients who had
no anticoagulant therapy for up to 7 years after valve replacement, an
aggregate of 122 patient-years. The 25 male and 23 female patients ranged
in age at implantation from 5 months to 21 years (12 +/- 6 years, mean +/-
standard deviation). Five patients (all with complex associated
malformation) died in the hospital (10%), and nine died late (22%). None of
the early and one of the late deaths was associated with a thrombosed
prosthesis. During follow-up, seven thrombotic (one mitral, one aortic) or
thromboembolic (two mitral, three aortic) events occurred (5.7 +/- 2.1 per
100 patient-years). Of these seven events, five occurred within the last 14
months of the study. There was no relation of these events to age of
patient at implantation, age at the time of even, gender, or site of
implantation. Concurrently, we have followed up 340 adult patients with St.
Jude Medical prostheses who had warfarin sodium (Coumadin) anticoagulation
for 875 patient-years. By the end of this study, the children who did not
receive anticoagulants were significantly less free of thrombotic and
thromboembolic events than the adults who did receive anticoagulants (p
less than 0.01).
ARTICLES
Valve prostheses in children: a reassessment of anticoagulation
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston.
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