TY - JOUR
T1 - Short- and long-term efficacy of aspirin and clopidogrel for thromboprophylaxis for mechanical heart valves
T2 - An in vivo study in swine
AU - McKellar, Stephen H.
AU - Thompson, Jess L.
AU - Garcia-Rinaldi, Raul F.
AU - MacDonald, Ryan J.
AU - Sundt, Thoralf M.
AU - Schaff, Hartzell V.
N1 - Funding Information:
This study used de-identified, point-of-care data collected by the Australian Palliative Care Outcomes Collaboration (PCOC) which is a national quality program funded by the Australian Government Department of Health.( Australian Health Services Research Institute, 2019 ) The PCOC program assesses patients in inpatient and community settings across various models of care. Inpatient services conduct detailed assessments on admission, and then at least daily to inform their care of individual patients. Community services perform assessment on admission and during each subsequent patient contact. The PCOC system bi-annually captures point-of-care data upon admission, at phase changes (defined below) and at discharge from the participating services. Data extracts are loaded into the database for the purpose of data validation and quality checking. The PCOC program conducts review and data-cleaning procedures before data aggregation and analyses, followed by submission back to all participating services. Six-monthly reports compare outcomes for each service with the national results and assess performance against industry agreed benchmarks. The program employs ‘improvement facilitators’ who work with clinical staff to ensure assessments and data collection are standardised.( Palliative Care Outcomes Collaboration, 2018 )
PY - 2008/10
Y1 - 2008/10
N2 - Objective: In the interest of exploring alternatives to warfarin, we tested the hypothesis that clopidogrel combined with aspirin is effective for thromboprophylaxis of mechanical valves using a swine model. Methods: Adult swine underwent heterotopic implantation of a modified bileaflet mechanical valved conduit bypassing the ligated, native descending thoracic aorta. Animals were randomized to no anticoagulation (n = 7), 175 U/kg dalteparin administered subcutaneously twice daily (n = 9), 325 mg of aspirin (n = 6), 75 mg of clopidogrel (n = 6), or 325 mg of aspirin and 75 mg of clopidogrel daily (n = 6) and survived for 30 days. Additionally, 11 animals were randomized to no anticoagulation (n = 5) or 325 mg of oral aspirin and 75 mg of clopidogrel daily (n = 6) and survived for 150 days. Results: At 30 days, we observed 216 ± 270 mg of thrombus for the no anticoagulation group, 53 ± 91 mg for the dalteparin group, 33 ± 23 mg for the aspirin group, 25 ± 10 mg for the clopidogrel group, and 17 ± 9 mg for the combined aspirin and clopidogrel group, respectively (P < .01 for clopidogrel and aspirin vs no anticoagulation). At 150 days, we observed 223 ± 200 mg of thrombus for the no anticoagulation group and 4 ± 4 mg for the aspirin and clopidogrel group (P = .02). Mean platelet deposition on the valve was 4.1 × 109 ± 3.6 × 109 for the no anticoagulation and 6.81 × 107 ± 1.4 × 108 for the combined aspirin and clopidogrel groups, respectively (P = .03). No major hemorrhagic events were observed. Conclusions: Effective short- and long-term thromboprophylaxis of mechanical valves can be achieved by using dual-antiplatelet therapy in this porcine model. Prospective human trials should be conducted with combination aspirin and clopidogrel as an alternative to warfarin in patients with bileaflet mechanical aortic valves.
AB - Objective: In the interest of exploring alternatives to warfarin, we tested the hypothesis that clopidogrel combined with aspirin is effective for thromboprophylaxis of mechanical valves using a swine model. Methods: Adult swine underwent heterotopic implantation of a modified bileaflet mechanical valved conduit bypassing the ligated, native descending thoracic aorta. Animals were randomized to no anticoagulation (n = 7), 175 U/kg dalteparin administered subcutaneously twice daily (n = 9), 325 mg of aspirin (n = 6), 75 mg of clopidogrel (n = 6), or 325 mg of aspirin and 75 mg of clopidogrel daily (n = 6) and survived for 30 days. Additionally, 11 animals were randomized to no anticoagulation (n = 5) or 325 mg of oral aspirin and 75 mg of clopidogrel daily (n = 6) and survived for 150 days. Results: At 30 days, we observed 216 ± 270 mg of thrombus for the no anticoagulation group, 53 ± 91 mg for the dalteparin group, 33 ± 23 mg for the aspirin group, 25 ± 10 mg for the clopidogrel group, and 17 ± 9 mg for the combined aspirin and clopidogrel group, respectively (P < .01 for clopidogrel and aspirin vs no anticoagulation). At 150 days, we observed 223 ± 200 mg of thrombus for the no anticoagulation group and 4 ± 4 mg for the aspirin and clopidogrel group (P = .02). Mean platelet deposition on the valve was 4.1 × 109 ± 3.6 × 109 for the no anticoagulation and 6.81 × 107 ± 1.4 × 108 for the combined aspirin and clopidogrel groups, respectively (P = .03). No major hemorrhagic events were observed. Conclusions: Effective short- and long-term thromboprophylaxis of mechanical valves can be achieved by using dual-antiplatelet therapy in this porcine model. Prospective human trials should be conducted with combination aspirin and clopidogrel as an alternative to warfarin in patients with bileaflet mechanical aortic valves.
UR - http://www.scopus.com/inward/record.url?scp=54049137962&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=54049137962&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2008.01.045
DO - 10.1016/j.jtcvs.2008.01.045
M3 - Article
C2 - 18954629
AN - SCOPUS:54049137962
SN - 0022-5223
VL - 136
SP - 908
EP - 914
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -