Prevalence of Anemia and Occult Blood Losses in the Long-Term Follow-Up of Cardiac Mechanic Valve Patients Treated with a Combination of Low-Dose Aspirin Plus Low-Intensity Acenocoumarin

Abstract

Mechanic replacement of cardiac prostheses requires lifelong and high-intensity oral anticoagulant treatment. The addition of aspirin to coumarin treatment has resulted in more effective thromboembolic prevention, though it also led to increased (digestive) bleeding. Aspiriri enhanced the risk of apparent or occult gastrointestinal bleeding in a dose-dependent fashion. The combined use of low-dose aspirin/low-intensity coumarins might offer a safer approach. We prospectively evaluated the prevalence of anemia markers in 127 prosthesic valve patients, receiving two treatment modalities: Group A comprised 62 patients who received 100 mg acetylsalicylic acid (ASA) added to acenocoumarin [international normatized ratio (INR) 2.5-3.5]. Group B comprised 65 patients receiving acenocoumarin alone (INR, 3.5-4.5). We found no significant differences in the mean values for the blood markers of anemia or for the presence of blood losses in urine and feces. The addition of low-dose ASA to less intense chronic anticoagulation does not increase the risk of developing anemia. Key Words: Anticoagulants—Aspirin—Coumarins—Gastrointestinal hemorrhage—Heart valve prosthesis.

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