Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior...

Area of Science:

• Cardiology
• Vascular Surgery
• Geriatric Medicine

Background:

• Limited data exists on discontinuing antiplatelet therapy with LMWH bridging in elderly patients with coronary stents (>12 months) undergoing non-cardiac surgery.
• This study aimed to evaluate the clinical benefits and risks of this specific bridging strategy.

Purpose of the Study:

• To compare the safety and efficacy of LMWH bridging therapy versus no bridging therapy in elderly patients with coronary stents undergoing non-cardiac surgery.
• To assess the rates of cardiac/cerebrovascular events and major bleeding.

Main Methods:

• A randomized controlled trial involving 2476 patients comparing LMWH (dalteparin sodium) bridging therapy to placebo.
• Primary endpoints included cardiac or cerebrovascular events (efficacy) and major bleeding (safety).

Main Results:

• The LMWH bridging group showed significantly lower rates of combined cardiac/cerebrovascular events (5.79% vs. 8.42%) and myocardial injury (3.14% vs. 5.19%).
• Deep vein thrombosis was more frequent in the non-bridging group (1.21% vs. 0.4%). No significant differences were observed in acute myocardial infarction, cardiac death, stroke, or major bleeding rates.
• Independent predictors of ischemic events included LMWH bridging, low creatinine clearance, low preoperative hemoglobin, and diabetes. Predictors of minor bleeding included LMWH bridging and low preoperative platelet count.

Conclusions:

• Perioperative LMWH bridging therapy is safe and effective for elderly patients with coronary stents (>12 months) undergoing non-cardiac surgery.
• An alternative strategy could involve using half-dose LMWH for bridging therapy.