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Peri-procedural anticoagulation management of mechanical prosthetic heart valve patients

Paul R Daniels1, Robert D McBane, Scott C Litin

  • 1Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.

Thrombosis Research
|February 24, 2009
PubMed

Insights

Thromboembolism risk is low in mechanical heart valve patients undergoing procedures when anticoagulation is paused. Bleeding events are more common, necessitating careful warfarin restart and individualized heparin bridging for high-risk patients.

Area of Science:

  • Cardiology
  • Hematology
  • Vascular Surgery

Background:

  • Mechanical heart valve (MHV) patients require anticoagulation management during invasive procedures.
  • Temporary interruption of anticoagulation poses risks of thromboembolism and bleeding.

Purpose of the Study:

  • To estimate the three-month cumulative incidence of thromboembolism and bleeding in MHV patients undergoing procedures.
  • To evaluate peri-procedural anticoagulation management strategies.

Main Methods:

  • Retrospective follow-up of 556 MHV patients over seven years (1997-2003).
  • Warfarin interruption prior to procedures, with individualized bridging therapy (LMWH or UFH) based on risk.
  • Three-month follow-up for thromboembolism, bleeding, and vital status.

Main Results:

  • The three-month cumulative incidence of thromboembolism was 0.9% (non-fatal).
  • The cumulative incidence of major bleeding was 3.6% (0.2% fatal).
  • Postoperative bleeding rates did not significantly differ between LMWH, UFH, or no heparin strategies.

Conclusions:

  • Peri-procedural anticoagulation interruption in MHV patients is associated with a low thromboembolism rate.
  • Bleeding complications are more frequent than thromboembolic events.
  • Restarting warfarin promptly and using heparin bridging selectively for high-risk patients is a recommended strategy.
Abstract

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