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Anticoagulant therapy in children with prosthetic valves
P S Rao1, L Solymar, M K Mardini
1Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Warfarin sodium is effective for preventing thromboembolic events in children with prosthetic valves, though it carries a bleeding risk. Aspirin plus dipyridamole showed limited efficacy and increased risk of fatal events.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Prosthetic heart valves in children require careful management to prevent complications.
- Anticoagulant therapy is crucial for long-term prosthetic valve function.
- Limited data exists on the comparative effectiveness of anticoagulants in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of different anticoagulant regimens in children with prosthetic heart valves.
- To compare warfarin sodium, aspirin plus dipyridamole, and no anticoagulation.
- To assess complication rates including thromboembolism and bleeding.
Main Methods:
- Retrospective analysis of 130 children (aged 1-19) undergoing left-sided valve replacement over 7 years.
- Categorization of survivors into warfarin, aspirin plus dipyridamole, or no anticoagulant groups.
- Follow-up for up to 8.2 years, totaling 544 patient-years.
Main Results:
- Warfarin showed a 4% bleeding complication rate in aortic valve replacement patients.
- Aspirin plus dipyridamole had a 2.5% thromboembolic rate in aortic valve replacement patients.
- Mitral valve replacement patients on warfarin had a 4% thromboembolic rate and 2% severe bleeding.
- Two fatal cerebrovascular accidents occurred in the aspirin plus dipyridamole group.
- No thromboembolic events occurred in patients with mitral heterografts on no anticoagulation.
- Double-valve replacement patients on warfarin had a 5% complication rate versus 27% without anticoagulation.
Conclusions:
- Warfarin sodium appears effective in preventing thromboembolic complications in pediatric prosthetic valve recipients.
- Aspirin plus dipyridamole may be less effective and carries a risk of fatal cerebrovascular events.
- No anticoagulation may be suitable for certain valve types like mitral heterografts.
- Individualized anticoagulant strategies are necessary for pediatric prosthetic valve management.
Abstract:
The purpose of this study was to evaluate the effectiveness and complications of several types of anticoagulant therapy in children with prosthetic valves. During a 7-year period ending April 1985, 130 children aged 1 to 19 years underwent left-sided valve replacement. Operative mortality was 3%, 5%, and 9%, respectively, for aortic, mitral, and aortic and mitral valve replacement. Among the 123 survivors, 32 (26%) had had aortic, 71 (58%) had had mitral, and 20 (16%) had had aortic and mitral valve replacement. Follow-up ranged from 2 months to 8.2 years, a total of 544 patient-years. The survivors were divided into three groups based on anticoagulant treatment: warfarin sodium, aspirin plus dipyridamole, and no anticoagulants. Among the patients who had aortic valve replacement, thromboembolic complications developed in 2.5% (2.5/100 patient-years) of the aspirin plus dipyridamole group and 5% of the group given no anticoagulants. Only the warfarin group (4%) experienced bleeding complications. Among the patients having mitral valve replacement, thromboembolic complications developed in 4% of the warfarin group, 3% of the aspirin plus dipyridamole group, and 11% of the no anticoagulant group. In addition, 2% of patients in the warfarin group experienced severe bleeding. Two fatal cerebrovascular accidents occurred, both in the aspirin plus dipyridamole group. Patients who received a mitral heterograft were not prescribed any anticoagulant medications, and no thromboembolic complications developed. Among patients having double-valve replacement, complications developed in 5% of the warfarin group and 27% of the group given no anticoagulants.(ABSTRACT TRUNCATED AT 250 WORDS)