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Bridging Anticoagulation After Mechanical Aortic Heart Valve Replacement: A Questionable Routine.
Laura C Guglielmetti1, Robert Sorabella1, Codruta Chiuzan2
1Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
The Annals of Thoracic Surgery
|April 13, 2016
Summary
Bridging anticoagulation therapy with heparin after mechanical aortic valve replacement increases bleeding risk. Thromboembolic events were infrequent, with no significant difference between groups in this study.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Mechanical aortic valve replacement (MAVR) necessitates anticoagulation.
- Bridging anticoagulation strategies aim to prevent thrombosis but may increase bleeding risk.
Purpose of the Study:
- To compare bleeding and thrombotic events in MAVR patients receiving warfarin alone versus warfarin with heparin bridging.
Main Methods:
- Retrospective study of 158 MAVR patients (2001-2014).
- Group 1: Warfarin only (n=53).
- Group 2: Warfarin plus heparin bridge (n=105).
- Outcomes: Bleeding and thromboembolic events during hospitalization.
Main Results:
- The warfarin plus heparin group had significantly higher rates of pericardial effusions (24% vs 8%) and reoperation for bleeding (8% vs 0%).
- All four thromboembolic events occurred in the warfarin plus heparin group.
- Heparin bridging was significantly associated with increased odds of bleeding (OR 4.46).
Conclusions:
- Postoperative heparin bridging in MAVR patients significantly increases bleeding complications.
- The study did not detect a statistically significant difference in thromboembolic event rates due to low incidence.
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