Combined Aspirin Study for Mechanical Prosthetic Valve in Kyushu and Ryukyu by Inter-University Hospital Network (ASPIRIN-Trial)
Abstract
BACKGROUND: The benefits of adding aspirin to warfarin and warfarin treatment intensity for Japanese patients with mechanical valve replacement (MeVR) are unclear. METHODS AND RESULTS: This multicenter non-randomized observational study recruited 158 Japanese patients who underwent MeVR in 11 university hospitals in Kyushu and Okinawa; 74 patients were allocated to the warfarin (W) group and 84 were allocated to the warfarin plus aspirin (W+A) group. Patients were followed for a mean (±SD) of 5.0±1.9 years. The primary and secondary endpoints were mainly atherosclerotic/thrombotic and bleeding events, respectively. There was no difference in the incidence of the primary endpoint between the W and W+A groups (14% vs. 22%, respectively; P=0.13). Univariate analysis revealed a higher incidence of the secondary endpoint in the W+A than W group (35% vs. 22%; P=0.032), but the difference was not significant in multivariate analysis. For the entire cohort, the postoperative mean international normalized ratio of prothrombin time (PT-INR) was relatively low (2.1±0.3). There were no differences in the incidence of events between PT-INR <2.0 and 2.0-3.0 (primary endpoint: 21% vs. 16%, respectively [P=0.41]; secondary endpoints: 33% vs. 26%, respectively [P=0.19]). CONCLUSIONS: Adding aspirin to warfarin treatment was not superior to warfarin alone, and relatively weak warfarin treatment (PT-INR <2.0) was not necessarily associated with an increased number of events (vs. PT-INR 2.0-3.0) in Japanese patients who underwent MeVR.
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BibTeX
@article{tsuda2026combined,
title = {{Combined Aspirin Study for Mechanical Prosthetic Valve in Kyushu and Ryukyu by Inter-University Hospital Network (ASPIRIN-Trial)}},
author = {Yuki Tsuda and Koichi Arinaga and Takashi Shuto and Hiromichi Sonoda and Kazuhisa Matsumoto and Shuhei Sakaguchi and Go Kuwahara and Masataka Eto and Jun Takaki and Hitoshi Inafuku and Masanori Takamatsu and Ichiro Matsumaru and Kazuyoshi Takagi and Takayuki Kawashima and Tomoki Ushijima and Hideaki Kanda and Kunihide Nakamura and Hiromitsu Teratani and Toru Yasutsune and Takashi Yoshinaga and Yuya Kise and Hiroyuki Morokuma and Kiyoyuki Eishi and Takashi Miura and Keiji Kamohara and Kojiro Furukawa and Toshihiro Fukui and Yosuke Nishimura and Hideichi Wada and Koji Furukawa and Yoshiharu Soga and Akira Shiose and Shinji Miyamoto and Eiki Tayama and Yoshihisa Fujino and Yutaka Otsuji and Masaharu Kataoka and on behalf of the ASPIRIN-Trial Investigators},
journal = {Circulation Journal},
year = {2026},
month = aug,
doi = {10.1253/circj.cj-25-0460},
url = {https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-25-0460/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Combined Aspirin Study for Mechanical Prosthetic Valve in Kyushu and Ryukyu by Inter-University Hospital Network (ASPIRIN-Trial)
AU - Yuki Tsuda
AU - Koichi Arinaga
AU - Takashi Shuto
AU - Hiromichi Sonoda
AU - Kazuhisa Matsumoto
AU - Shuhei Sakaguchi
AU - Go Kuwahara
AU - Masataka Eto
AU - Jun Takaki
AU - Hitoshi Inafuku
AU - Masanori Takamatsu
AU - Ichiro Matsumaru
AU - Kazuyoshi Takagi
AU - Takayuki Kawashima
AU - Tomoki Ushijima
AU - Hideaki Kanda
AU - Kunihide Nakamura
AU - Hiromitsu Teratani
AU - Toru Yasutsune
AU - Takashi Yoshinaga
AU - Yuya Kise
AU - Hiroyuki Morokuma
AU - Kiyoyuki Eishi
AU - Takashi Miura
AU - Keiji Kamohara
AU - Kojiro Furukawa
AU - Toshihiro Fukui
AU - Yosuke Nishimura
AU - Hideichi Wada
AU - Koji Furukawa
AU - Yoshiharu Soga
AU - Akira Shiose
AU - Shinji Miyamoto
AU - Eiki Tayama
AU - Yoshihisa Fujino
AU - Yutaka Otsuji
AU - Masaharu Kataoka
AU - on behalf of the ASPIRIN-Trial Investigators
PY - 2026
DA - 2026/08/25
JO - Circulation Journal
DO - 10.1253/circj.cj-25-0460
UR - https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-25-0460/_article
AB - BACKGROUND: The benefits of adding aspirin to warfarin and warfarin treatment intensity for Japanese patients with mechanical valve replacement (MeVR) are unclear. METHODS AND RESULTS: This multicenter non-randomized observational study recruited 158 Japanese patients who underwent MeVR in 11 university hospitals in Kyushu and Okinawa; 74 patients were allocated to the warfarin (W) group and 84 were allocated to the warfarin plus aspirin (W+A) group. Patients were followed for a mean (±SD) of 5.0±1.9 years. The primary and secondary endpoints were mainly atherosclerotic/thrombotic and bleeding events, respectively. There was no difference in the incidence of the primary endpoint between the W and W+A groups (14% vs. 22%, respectively; P=0.13). Univariate analysis revealed a higher incidence of the secondary endpoint in the W+A than W group (35% vs. 22%; P=0.032), but the difference was not significant in multivariate analysis. For the entire cohort, the postoperative mean international normalized ratio of prothrombin time (PT-INR) was relatively low (2.1±0.3). There were no differences in the incidence of events between PT-INR <2.0 and 2.0-3.0 (primary endpoint: 21% vs. 16%, respectively [P=0.41]; secondary endpoints: 33% vs. 26%, respectively [P=0.19]). CONCLUSIONS: Adding aspirin to warfarin treatment was not superior to warfarin alone, and relatively weak warfarin treatment (PT-INR <2.0) was not necessarily associated with an increased number of events (vs. PT-INR 2.0-3.0) in Japanese patients who underwent MeVR.
SN - 1347-4820
SN - 1346-9843
ER -