INCIDENCE OF EMBOLI WITH CLOTH-COVERED STARR-EDWARDS VALVE WITHOUT ANTICOAGULATION AND WITH VARYING FORMS OF ANTICOAGULATION - ANALYSIS OF 183 PATIENTS FOLLOWED FOR 3 1/2 YEARS
Patients (183) with cloth-covered valves were studied from 1 1/2 to 8 yr after operation, with an average follow-up time of 3 1/2 yr. Over the total period, patients taking Coumadin sustained a 4% embolic incidence (1.2/100 patient-years); those taking aspirin had a 7% incidence (2.6/100 patient-years); and those taking Persantine had a 43% incidence (10/100 patient-years). Patients on no regimen of anticoagulation had a 16% embolic rate (4/100 patient-years); another group of patients who stopped anticoagulants after a year incurred a 13% embolic incidence in the subsequent 2 yr (6.4/100 patient-years). A significantly lowered embolic rate was seen with anticoagulation. All patients with cloth-covered valves should be taking anticoagulants. That these valves become epithelialized and do not form thrombus after a year was not borne out by this study. Persantine alone is not a satisfactory anticoagulant. Coumadin appears to be the superior anticoagulant, but if careful monitoring of its use is in question or if serious bleeding complications ensue, aspirin may provide satisfactory protection.