Anticoagulation in Children With Mechanical Valve Prostheses

Abstract

Background. Clotting complications in patients with mechanical valve prostheses can be prevented with either warfarin sodium (Coumadin; DuPont, Wilmington, DE) or antiplatelet agents. In children, it is not known whether one treatment regimen is more effective or safe than the other. Methods. We prospectively followed up 64 children and young adults (aged 18 years or younger at implantation) with a mechanical valve on the left side of the heart, from October 1986 through October 1996. Forty-eight patients were treated with Coumadin and 16 with aspirin and dipyridamole. The two groups were similar in age, sex, valve location and size, mean length of follow-up, and operative indication. There has been a total follow-up of 272 patient-years on Coumadin and 116 patient-years on aspirin and dipyridamole. Results. There was no difference between the two groups in survival or freedom from thromboembolism. Bleeding occurred more often in the patients taking Coumadin, but this difference was not statistically significant. Analysis of the literature showed thromboembolism and bleeding rates to be similar in the patients receiving Coumadin and those receiving antiplatelet agents. Conclusions. Coumadin and the combination of aspirin plus dipyridamole provided similar protection against complications in this group of children and young adults with left-sided St. Jude (St. Paul, MN) mechanical valves. The choice between the two regimens may depend on other factors, such as patient preference and convenience.