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Evidence summaries

Dipyridamole in Combination of Anticoagulant Therapy in Patients with Prosthetic Heart Valves

Dipyridamole combined with anticoagulants may be beneficial compared with anticoagulants alone; however there is heterogeneity of results on overall mortality Level of evidence: "C"

A systematic review 1 including 6 studies with a total of 1 141 subjects was abstracted in DARE. The combination of dipyridamole and anticoagulants reduced the risk of thromboembolic events (fatal or nonfatal) by 56% (95% CI 33% to 71%) when compared to anticoagulants alone. The overall mortality rate was reduced by 40% (95% CI 10% to 60%) in the group receiving dipyridamole. However, for this end point, there was significant heterogeneity between trials, most of the benefit in terms of overall mortality coming from one trial, and includes a large perioperative mortality difference between groups which occurred before drug treatment started. The frequency of haemorrhagic events did not differ between treatment groups (risk reduction -1%, p=0.94).

Comment: The quality of evidence is downgraded by inconsistency of results and limitations of review methodology. The review offers no formal quality assessment of individual studies.

    References

    • Pouleur H, Buyse M. Effects of dipyridamole in combination with anticoagulant therapy on survival and thromboembolic events in patients with prosthetic heart valves. A meta-analysis of the randomized trials. J Thorac Cardiovasc Surg 1995 Aug;110(2):463-72. [PubMed] [DARE]

Primary/Secondary Keywords