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QUESTION: In patients with mechanical prosthetic heart valves, are combined oral anticoagulants and antiplatelet treatment more efficacious than anticoagulants alone?
Studies were identified by searching Medline (1966 to November 1999) with the terms heart valve prosthesis, mechanical heart valve, thromboembolism, anticoagulant, antiplatelet, and haemorrhage. Bibliographies of studies, reviews, meta-analyses, and consensus statements were also checked.
Full text and abstracts of randomised controlled trials were selected if patients with prosthetic heart valves were studied, oral anticoagulation plus antiplatelet agents were compared with oral anticoagulation alone, and objective methods were used to assess outcomes and adverse effects.
Data were extracted on study characteristics and quality; interventions, including type and duration of anticoagulation and antiplatelet agents; target international normalised …
Source of funding: not stated.
For correspondence: Dr D Massel, London Health Sciences Center, Room 205, Colborne Building, Victoria Campus, 375 South Street, London, Ontario N6A 4G5, Canada. Fax +1 519 667 6687/6648.