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Combination of oral anticoagulant and platelet inhibitor drugs: focus on the pharmacological aspects of optimizing antithrombotic therapy in mechanical heart valve replacement

K. Schror*

Institut für Pharmakologie and Klinische Pharmakologie, Universitdtsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany

* Correspondence: K. Schror, Institut fur Pharmakologie und Klinische Pharmakologie, Universitdtsklinikum Düsseldorf, Heinrich- Heine-Universität, Moorenstr. 5, 40225 Düsseldorf, Germany.

Abstract

Patients with mechanical heart valve replacement require continuous antithrombotic treatment, mainly with oral anticoagulants of the coumarin type. Coumarins are currently applied in doses that generate an International Normalized Ratio (INR) between 2·5 and 3·5. A further increase in INR would improve the therapeutic outcome, but also would increase risk for bleeding. The combined use of coumarins at medium INR with antiplatelet drugs reduces the incidence of thromboembolic events at the risk of increased bleeding. Thus, the overall effect would appear to be the same.

Key Words: Aspirin • clopidogrel • oral anticoagulants • phenprocoumon • valve replacement • warfarin

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