Journal Article

Intensity of oral anticoagulation after implantation of St. Jude Medical mitral or multiple valve replacement: lessons learned from GELIA (GELIA 5)

D. Pruefer, M. Dahm, G. Dohmen, D. Horstkotte, R. Bergemann and H. Oelert

in European Heart Journal Supplements

Published on behalf of European Society of Cardiology

Volume 3, issue suppl_Q, pages Q39-Q43
Published in print December 2001 | ISSN: 1520-765X
Published online December 2001 | e-ISSN: 1554-2815 | DOI: http://dx.doi.org/10.1016/S1520-765X(01)90041-0
Intensity of oral anticoagulation after implantation of St. Jude Medical mitral or multiple valve replacement: lessons learned from GELIA (GELIA 5)

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Aims The purpose of the present analysis was to determine survival rate, and risk for thromboembolic and bleeding complications after mechanical heart valve replacement with St. Jude Medical mechanical heart (bileaflet) valves under differing regimens of postoperative anticoagulation.

Method In the randomized German Experience with Low Intensity Anticoagulation (GELIA) study, 553 patients after mitral valve replacement and 158 patients after double valve replacement with a St. Jude Medical prosthesis were randomly assigned to three groups for postoperative oral anticoagulation: group A, target International Normalized Ratio (INR) range 3·0–4·5; group B, target INR range 2·5–4·0; and group C, target INR range 2·0–3·5.

Results The various anticoagulation regimens had no significant impact on risk for bleeding or thromboembolism, or cumulative survival rate after mitral valve replacement. However, less intensive anticoagulation (target INR range 2·0–3·5) was associated with a significant decrease in cumulative survival rate after combined valve replacement, although analysis confirmed that 54% of these deaths were not valve related.

Conclusion The results suggest that in terms of low-intensity anticoagulation an INR of 2·0–3·5 after mitral valve replacement and of 2·5–4·0 after double valve replacement (aortic and mitral) may be recommended when using the St. Jude Medical bileaflet prosthetic valve.

Keywords: Anticoagulant regimen; bleeding; heart valve prosthesis; survival rate; thromboembolism

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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