Safety of parenteral anticoagulation as a bridge to warfarin in patients undergoing mechanical aortic valve...

To evaluate bleeding rates among patients who received a mechanical aortic valve replacement (mAVR) treated with warfarin monotherapy versus warfarin with a therapeutic parenteral anticoagulant bridge.

This retrospective, single-center, observational study included patients at least 18 years old who received an mAVR and had anticoagulation ordered by the end of postoperative day 2. Exclusion criteria included an INR goal other than 2-3, a hypercoagulable state, postoperative mechanical circulatory support, delayed sternal closure, pregnancy or incarceration. The primary outcome was International Society of Thrombosis and Hemostasis major bleeding until hospital discharge or 30 days after valve replacement, whichever came first. Secondary outcomes included thromboembolic events, hospital length of stay, and mortality.

A total of 143 patients were included in the final analysis, 112 patients in the therapeutic anticoagulation bridge group and 31 patients in the warfarin monotherapy (no-bridge) group. Eighty-seven percent of the patients were white and 69.2% were male, and the median age was 49 years (interquartile range [IQR], 41-58 years). Sixteen patients (14.3%) in the bridge group experienced a major bleed, compared to 0 patients in the no-bridge group (P = .02). Thromboembolic events occurred in 6.5% of patients in the no-bridge group versus 2.7% in the bridge group (P = .30). There was no difference in mortality between the 2 groups (P = .99).

The use of therapeutic parenteral anticoagulation with warfarin after mAVR significantly increased the rate of major bleeding compared to warfarin monotherapy. Larger prospective studies are needed to confirm these findings.