Low-dose Oral Anticoagulation and Antiplatelet Therapy with
St. Jude Medical Heart Valve Prosthesis
Birol Yamak MD, Zafer Iscan MD, Binali Mavita MD, A. Tulga Ulus MD,
S. Fehmi Katircioglu MD, Oguz Tasdemir MD, Kemal Bayazit MD

Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been used at the authors' institution. We report our experience with oral anticoagulation and antiplatelet therapy following SJM valve implantation. Among 2,585 patients (mean age 40.3 ± 13.5 years) living in a rural environment, 865 underwent aortic valve replacement (AVR), 1,231 mitral valve replacement (MVR) and 489 double valve replacement (DVR). All patients received warfarin (2.5 mg/day) and antiaggregation therapy (dypridamole 3 x 75 mg/day plus aspirin 100 mg/day). Postoperatively, 139 adverse events occurred (51 after AVR, 58 after MVR, 30 after DVR); operative mortality rates were 5.9%, 4.7% and 6.1%, respectively in these groups. Operative mortality was most often due to low cardiac output. During follow up, there were 88 anticoagulant hemorrhages (1.2%/pt-yr), 11 paravalvular leaks (0.2%/pt-yr), 52 thromboembolisms (0.7%/pt-yr), 60 mechanical valve thromboses (0.8%/pt-yr) and 78 reoperations (1.1%/pt-yr). Complications occurred in 101 patients after AVR, 125 after MVR, and 63 after DVR (4.2%, 3.7% and 4.6% per pt-yr, respectively). Patient age, concomitant surgery and late valve-related complications were significant mortality factors after AVR; previous surgery was a significant risk factor for operative mortality after MVR; female gender and age were significant risk factors for operative mortality after DVR. In conclusion, implantation of the SJM mechanical heart valve prosthesis, combined with 2.5 mg/day warfarin and dipyridamole/aspirin, provided satisfactory results in this patient group.