HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Erratum (v28,p188) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): José Ignacio Aramendi Vicente Campos Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aramendi, J. I. Articles by Navas, C. Search for Related Content PubMed PubMed Citation Articles by Aramendi, J. I. Articles by Navas, C. Related Collections Valve disease

Eur J Cardiothorac Surg 2005;27:854-860
© 2005 Elsevier Science NL

Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial

^a Division of Cardiovascular Surgery Hospital de Cruces, Plaza de Cruces s/n, Barakaldo 48903, Spain
^b Department of Cardiovascular Surgery Hospital Clinic, Barcelona, Spain
^c Department of Cardiovascular Surgery Hospital Clinico, Valencia, Spain
^d Department of Cardiac Surgery Hospital Juan Canalejo, La Coruña, Spain
^e Medical Department J Uriach y Compañía, Barcelona, Spain

Received 14 September 2004; received in revised form 20 December 2004; accepted 27 December 2004.

^* Corresponding author. Tel.: +34 94 600 63 39; fax: +34 94 600 6076. (E-mail: jiaramendi{at}hcru.osakidetza.net).

Objective: Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. Up to date, however, results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study was to compare the efficacy and safety of triflusal (an antiplatelet agent) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis. Methods: In this prospective, multicentric, randomized, open pilot trial, patients were assigned to treatment with triflusal (600mg/d) or acenocoumarol (target INR 2.0–3.0). Study medication was started 24–48h after valve replacement with a bioprosthesis, and continued for 3 months. Four follow-up visits were scheduled: baseline, and at 1, 3 and 6 months thereafter. The primary end-point was a composite of the rate of thromboembolism, severe hemorrhage and valve-related mortality. Results: A total of 193 patients were included (97 received triflusal and 96 acenocoumarol), with a mean age of 72.5 years. Half were men. Aortic valve replacement was performed in 181 patients (93.8%), mitral valve replacement in 10 patients (5.2%) and double valve replacement in 2 (1.0%). Hospital mortality was 11 (5.7%). Primary outcome was recorded in 9 patients with triflusal (9.4%) and in 10 patients with acenocoumarol (11%). There were nine episodes (4.7%) of thromboembolism, six in the triflusal group and three in the acenocoumarol group, and three episodes of permanent neurological deficits, one in the triflusal group and two in the acenocoumarol group. Severe hemorrhage: nine episodes, six in the acenocoumarol group and three in the triflusal group. None of the observed differences in efficacy were statistically significant. Regarding safety, three patients in triflusal group reported at least one hemorrhage, compared to 10 in acenocoumarol group (P=0.048). Conclusions: There were no significant differences in efficacy between both groups, however, triflusal showed a significantly lower incidence of bleeding episodes.

Key Words: Antiplatelet drugs • Acenocoumarol • Triflusal • Bioprosthesis • Thromboembolism

This article has been cited by other articles:

				D. N. Salem, P. T. O'Gara, C. Madias, and S. G. Pauker Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 593S - 629S. [Abstract] [Full Text] [PDF]

				J. I. Aramendi and C.-A. Mestres Antithrombotic therapy after bioprosthetic aortic valve replacement Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 529 - 530. [Full Text] [PDF]

				J. Nowell and M. Jahangiri Antiplatelet therapy after bioprosthetic aortic valve replacement is unnecessary in patients without thromboembolic risk Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 945 - 945. [Full Text] [PDF]

				A. Colli, J.-P. Verhoye, A. Leguerrier, and T. Gherli Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 573 - 577. [Abstract] [Full Text] [PDF]

				J. Nowell, E. Wilton, H. Markus, and M. Jahangiri Antithrombotic therapy following bioprosthetic aortic valve replacement Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 578 - 585. [Abstract] [Full Text] [PDF]

				J. I Aramendi and C. A. Mestres ICVTS on-line discussion A Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 765 - 766. [Full Text] [PDF]