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Antiplatelet therapy in children with left-sided mechanical prostheses
J G LeBlanc1, S S Sett, D J Vince
1Department of Cardiovascular and Thoracic Surgery, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Summary
Pediatric valve replacement using warfarin followed by antiplatelet therapy showed no deaths and low thromboembolism. This approach effectively manages anticoagulation in children undergoing cardiac valve surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Medicine
- Prosthetic Valve Research
Background:
- Pediatric valve replacement historically faces challenges including high mortality, prosthetic valve outgrowth, and anticoagulation management difficulties.
- Left-sided cardiac valve replacement in children requires careful consideration of surgical techniques and long-term patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of a specific anticoagulation regimen in pediatric patients undergoing left-sided cardiac valve replacement.
- To assess the incidence of thromboembolism, bleeding, and valve thrombosis in children following prosthetic valve implantation.
Main Methods:
- Retrospective analysis of 20 pediatric patients (median age 85 months) who underwent left-sided cardiac valve replacement between 1985 and 1991.
- Utilized Bjork-Shiley and St. Jude prostheses for aortic and left atrioventricular valve replacements.
- Employed a 3-month warfarin regimen followed by long-term aspirin and persantine therapy.
Main Results:
- No early or late mortality was observed in the study cohort.
- A low incidence of thromboembolism (1.7%/patient-year) and bleeding (6.8%/patient-year) was reported.
- No instances of valve thrombosis occurred during the median follow-up of 12.3 months.
Conclusions:
- The anticoagulation strategy of initial warfarin followed by long-term antiplatelet therapy is associated with a low risk of thromboembolic events and no valve thrombosis in pediatric cardiac valve replacement.
- This regimen appears effective in managing anticoagulation and improving outcomes for children requiring prosthetic valve implantation.