Varfarina ou Aspirina na prevenção de fenômenos embólicos na valvopatia mitral com fibrilação atrial

Lavitola, Paulo de Lara; Sampaio, Roney Orismar; Oliveira, Walter Amorim de; Bôer, Berta Napchan; Tarasoutchi, Flávio; Spina, Guilherme Sobreira; Grinberg, Max

doi:10.1590/s0066-782x2010005000140

Cited by 9 publications

(6 citation statements)

References 21 publications

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“…And claim that this has a low early and late mortality, a high survival free of complications and low need for reoperation. Lavitola et al19 compared the effectiveness of Aspirin vs. Warfarin in thromboembolism prevention in patients with Atrial fibrilation and claim that in patients presenting fibrillation for less than a year and no previous embolism, aspirin is little effective. However, in patients with lower-risk mitral valvulopathy (mitral regurgitation and mitral biological prosthesis), especially in cases presenting contraindication to or low adherence to warfarin, aspirin use can present some benefit in thromboembolism prevention.…”

Section: Introductionmentioning

confidence: 99%

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

Patel¹,

Caramelli²,

Gomes³

2011

Clinics

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Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both clinical and exprimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.

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Section: Introductionmentioning

confidence: 99%

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

Patel¹,

Caramelli²,

Gomes³

2011

Clinics

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“…Characteristics of the 8 trials are summarized in Tables 1 and 2 . With the exception of the studies by Lavitola et al 27 and Hu et al, 34 participants in the studies were >70 years of age, and the ages of the participants were generally similar between the treatment arms. The number of participants in the anticoagulant treatment arms ranged from 36 to 555 (n = 2169), whereas the number in the antiplatelet treatment arms ranged from 39 to 545 (n = 2194).…”

Section: Resultsmentioning

confidence: 89%

“… 26 Thus, 9 articles met the inclusion criteria and were included in the analysis. 7 , 27 – 34 Two of the articles report findings of the Stroke Prevention in AF II study. 31 , 32 However, because each article presented unique data, both were included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, their findings agree with our own subgroup analysis. Seven of 8 studies included in our analysis (the Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA), Primary Prevention of Arterial Thromboembolism in Nonrheumatic Atrial Fibrillation, AFASAK I and II, Chinese Antithrombotic Therapy in Atrial Fibrillation Study, WASPO, and SPAF II) were also included in the analysis by Hart et al 42 However, their analysis included the EAFT study, 43 which assessed secondary prevention in patients with NRAF (N = 455), but not that of Lavitola et al, 27 which enrolled patients with rheumatic mitral valve disease (RMVD) (N = 229). Aguilar et al 40 included the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE W) study, which used clopidogrel (N = 6706) in their analysis, but they did not include the BAFTA study (N = 973).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Oral Anticoagulants Versus Aspirin for Patients With Atrial Fibrillation

2015

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The purpose of this study was to perform a meta-analysis comparing the effectiveness and safety of anticoagulation to antiplatelet therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF).MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched for studies published through May 31, 2014. Randomized controlled trials comparing anticoagulants (warfarin) and antiplatelet therapy in patients with AF were included. The primary outcomes were the rates of stroke and systemic embolism. Secondary outcomes included the rates of hemorrhage/major bleeding and death. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Nine reports of 8 trials that enrolled 4363 patients (2169 patients received anticoagulation and 2194 antiplatelet therapy) were included. All of the studies compared adjusted-dose warfarin or with aspirin, and the majority of the patients were >70 years of age. Anticoagulants were titrated to an international normalized ratio (INR) of 2.0 to 4.5, and aspirin was administered at a dosage of 75 to 325 mg/d. Death occurred in 206 participants treated with an anticoagulant and 229 participants treated with antiplatelet therapy. There was no significant difference in the overall stroke rate between the groups (OR = 0.667, 95% CI 0.426–1.045, P = 0.08); however, patients with nonrheumatic AF (NRAF) treated with an anticoagulant had a lower risk of stroke (OR = 0.557, 95% CI 0.411–0.753, P < 0.001). Anticoagulants were associated with a lower risk of embolism (OR = 0.616, 95% CI = 0.392–0.966, P = 0.04), and this finding persisted in patients with NRAF (OR = 0.581, 95% CI 0.359–0.941, P = 0.03). No significant difference in the rate of hemorrhage/major bleeding was noted (OR = 1.497, 95% CI 0.730–3.070, P = 0.27), and this finding persisted on subgroup analysis.Anticoagulants appear to be more effective than aspirin in preventing embolisms in patients with AF, as the risk of bleeding is not increased.

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“…For Lavitola et al [ 4 ] in certain situations, in patients with mitral bioprosthesis in the presence of atrial fibrillation, where is commonly indicated prophylaxis with oral anticoagulants, the replacement of the anticoagulant by aspirin could be considered. However, for mechanical prostheses, continuous oral administration of antivitamin K would always be indispensable, with or without concomitant atrial fibrillation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

Campos¹

2014

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionPatients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation.ObjectiveTo compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy.MethodsWe studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events.ResultsThe actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve.ConclusionPatients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature.

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Varfarina ou Aspirina na prevenção de fenômenos embólicos na valvopatia mitral com fibrilação atrial

Abstract: Background: Atrial fibrillation (AF) associated to rheumatic mitral valve disease (RMVD) increases the incidence of thromboembolism (TE), with warfarin being the standard therapy, in spite of difficulties in treatment adherence and therapeutic control.

Cited by 9 publications

References 21 publications

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

Efficacy and Safety of Oral Anticoagulants Versus Aspirin for Patients With Atrial Fibrillation

Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

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