Management of Thrombo-Embolism after Aortic Valve Replacement with the Björk-Shiley Tilting Disc Valve: Medicamental Prevention with Dicumarol in Comparison with Dipyridamole—Acetylsalicylic Acid. Surgical Treatment of Prosthetic Thrombosis

Dicumarol anticoagulation proved very effective in the prevention of thromboembolic complications after aortic valve replacement with the Bjork-Shiley tilting disc valve. We have, however, encountered six late deaths because of massive cerebral haemorrhage, which represent 3 % of the patients who were maintained on dicumarol medication at that time. This unacceptable mortality prompted us to introduce two programmes, one without anticoagulation and another one with dipyridamole-acetylsalicylic acid. Furthermore, dicumarol was terminated in patients with haemorrhagic episodes, instable anticoagulation, pregnancy, and in those requiring surgery. The results were disappointing, however, and the majority of the patients involved were therefore put on dicumarol medication.Eleven of the 64 consecutive patients taking dipyridamole - acetylsalicylic acid had thrombo-embolic episodes during a mean follow-up period of 9 months. Without anticoagulation, 3/27 patients were affected during 6 months and 5/32 during 12 ...