Effect of Dipyridamole on Thromboembolism Following Prosthetic Valve Replacement-Clinical Evaluation in Patients with a Starr-Edwards Ball Valve Replacement
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Thromboembolism is a major cause of morbidity and mortality in patients with a prosthetic heart valve in the follow-up period after surgery.Warfarin, as one of potent oral anticoagulants, has been used generally to prevent this complication. On the other hand, concerning platelet kinetics in the thrombus formation, Dipyridamole is known to decrease platelet adhesiveness and aggregation, and to reduce the incidence of thromboembolism when it is administered in addition to an oral anticoagulant.In this paper, effect of Dipyridamole on thromboembolic complication was evaluated from clinical point in connection with the relationship between the designs of Starr-Edwards ball valve and anticoagulations.Total 186 patients with the non-cloth and cloth coverd Starr-Edwards ball valve including 108 mitral, 41 aortic, 24 combined mitral and aortic, and 13 combined mitral and tricuspid regions were assessed from thromboembolic complication. The incidence of thromboembolism was shown in the emboli per patient years from the average time of follow-up and the number of the emboli happened after counting the duration of anticoagulation, withdrawal or restart of anticoagulants in individual patient.In these groups, the patients with Dipyridamole alone were evaluated, and 3 episodes of cerebral embolism were observed in 2 patients with the non-cloth covered mitral valve and 1 patient with the cloth covered aortic valve respectively. Four episodes of T. I. A. were also noted in each patient with the non-cloth and cloth covered mitral, cloth covered aortic and combined mitral and aortic valve. However, when Dipyridamole was given to the patients with Warfarin or Warfarin with Bucolome, only 3 episodes of T. I. A. were observed through these groups.On the other hand, the results of thromboembolic complication in the patients treated with Warfarin or Warfarin with Bucolome showed much higher incidences of T. I. A. and cerebral embolism than those with the combination of Dipyridamole and Warfarin or Warfarin with Bucolome.As a conclusion, 1) Dipyridamole should be given as an adjuvant in addition to an potent oral anticoagulant. But in patients with Starr-Edwards aortic valve. Dipyridamole alone can be allowed to use only after a definite time of strict anticoagulation. 2) In this series, the patients with the combination of Dipyridamole with Warfarin or Warfarin with Bucolome did not experience cerebral embolism. It may be advisable to supplement Dipyridamole to the patients with Warfarin alone. 3) Daily dosage of Dipyridamole is 300 to 400mg from theoretical reason, however, in this series, 200 to 250mg will also prevent serious thromboembolic complication.
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