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Enoxaparin as bridging anticoagulant treatment in cardiac surgery
N Rivas-Gándara1, I Ferreira-González, P Tornos
1Department of Medicine, Universitat Autonóma de Barcelona, Vall d'Hebron Hospital, Barcelona, Spain.
Insights
Enoxaparin shows a reasonable safety profile for bridging anticoagulation in cardiac surgery patients. Further randomized trials are needed to confirm its efficacy and safety in this population.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Thromboembolic Disease Management
Background:
- Cardiac surgery patients often require temporary anticoagulation (bridging therapy) to prevent thromboembolic events.
- Assessing the safety and efficacy of different anticoagulant agents for bridging therapy is crucial.
Purpose of the Study:
- To evaluate enoxaparin as a bridging anticoagulant in patients undergoing cardiac surgery.
- To determine the rate of thromboembolic events and major bleeding associated with enoxaparin bridging therapy.
Main Methods:
- A prospective registry of 140 cardiac surgery patients requiring long-term anticoagulation was analyzed.
- Subcutaneous enoxaparin was administered as bridging therapy according to a protocol.
- Patients were followed for 3 months to assess outcomes.
Main Results:
- 4.3% of patients experienced thromboembolic events, with 2.9% plausibly related to enoxaparin.
- 4.3% of patients had major bleeding events, with 2.1% plausibly related to enoxaparin.
- Enoxaparin was initiated on average 1 day post-surgery.
Conclusions:
- Enoxaparin appears to have a reasonable safety profile for bridging anticoagulation in cardiac surgery.
- Randomized controlled trials are necessary to definitively establish the efficacy and safety of enoxaparin in this context.
Objective:
To assess enoxaparin as bridging anticoagulant treatment in cardiac surgery.
Methods:
Prospective registry of those patients who underwent cardiac surgery in our centre between December 2003 and June 2004 and required long-term anticoagulation. Subcutaneous enoxaparin was used as bridging anticoagulant treatment according to a pre-established protocol. The global thromboembolic risk was carefully assessed in all patients. All patients were followed up for 3 months.
Results:
Of 140 patients who were included (mean (SD) age 66 (11); 49% female), 51 were already receiving long-term acenocumarol treatment before the index intervention. 50% of the patients were at high or very high risk for thromboembolic events in the postoperative period. The mean (SD) number of days between surgery and the first dose of anticoagulant was 2.01 (7) for acenocumarol and 1 (1.01) for enoxaparin. The mean (SD) daily dose of enoxaparin was 1.1 (0.27) mg/kg. Six thromboembolic events (4.3%; 95% CI 1.6 to 9.1) occurred, but only four of them were plausibly related to enoxaparin (2.9%; 95% CI 0.8 to 7.1). Six major haemorrhagic events (4.3%; 95% CI 1.6 to 9.1) occurred, but only three were plausibly related to enoxaparin (2.1%; 95% CI 0.4 to 6.1).
Conclusions:
These findings show a reasonable rate of adverse events using enoxaparin as bridging anticoagulant treatment in cardiac surgery. Randomised studies are necessary to evaluate the real efficacy and safety of enoxaparin as bridging anticoagulant treatment in cardiac surgery.
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