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Published on: February 26, 2013
Anticoagulant bridging in left-sided mechanical heart valve patients
Insights
Bridging anticoagulation with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for mechanical heart valves carries risks, primarily bleeding complications. Both UFH and LMWH strategies showed similar safety profiles in this study.
Area of Science:
- Cardiology
- Thrombosis Management
- Anticoagulation Therapy
Background:
- Patients with mechanical heart valves require temporary discontinuation of anticoagulation for high-risk procedures.
- Bridging therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is standard practice.
- This study evaluates the safety of UFH versus LMWH bridging in left-sided mechanical heart valve patients.
Purpose of the Study:
- To compare the safety and efficacy of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH) as bridging anticoagulation strategies.
- To assess the incidence of adverse events, including major bleeding, thromboembolism, and mortality, in patients with mechanical heart valves undergoing invasive procedures.
Main Methods:
- Retrospective multicenter study involving four surgical centers in The Netherlands.
- Inclusion of patients with mechanical heart valve implantation bridged between January 2010 and January 2015.
- Recording of cumulative incidence of adverse events within 30 days post-procedure, including major bleeding (ISTH criteria), symptomatic thromboembolism, and mortality.
Main Results:
- A total of 238 bridging episodes were analyzed.
- The incidence of major bleeding was comparable between UFH (19%) and LMWH (19%) groups (p=0.97).
- Rates of thromboembolism (2.4% vs 0.6%) and death (1.2% vs 1.9%) were low for both strategies, with bleeding complications being the most frequent adverse events.
Conclusions:
- Bridging anticoagulation in mechanical valve patients is associated with significant risks, predominantly bleeding.
- No significant difference in safety was observed between unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) bridging strategies.
- Both UFH and LMWH demonstrated low rates of thromboembolism and mortality, underscoring the importance of careful bleeding risk management.
Background:
In preparation for an invasive procedure with a high bleeding risk, patients with a mechanical heart valve temporarily have to discontinue their anticoagulant therapy and are usually bridged with either intravenous unfractionated heparin (UFH) or subcutaneous low-molecular-weight heparin (LMWH). In this study we retrospectively analyzed the safety of UFH versus LMWH as bridging strategy in left-sided mechanical heart valve patients.
Methods:
We performed a retrospective multicenter study in four surgical centers in The Netherlands. Patients with a mechanical heart valve implantation bridged from January 2010 until January 2015 were included. The cumulative incidence of adverse events in the 30days following the procedure was recorded. Main outcomes were major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, symptomatic thromboembolism, and mortality.
Results:
In total, 238 (174 aortic, 42 mitral, 22 aortic+mitral) bridging episodes were included. The incidence of major bleeding was 16 (19%) events in the UFH group versus 29 (19%) events in the LMWH group (p=0.97). Incidences of thromboembolism were 2 (2.4%) versus 1 (0.6%). The incidence of death was 1 (1.2%) patient in the UFH group versus 3 (1.9%) patients in the LMWH group. More than 50% of all bleeding complications were categorized as a major bleeding.
Conclusions:
Bridging anticoagulation in patients with aortic and mitral mechanical valves is associated with considerable risk, but no difference was apparent between UFH and LMWH strategy. The rate of thromboembolism and death was low with either strategy and the vast majority of adverse events were bleedings.
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