[Perioperative Bridging with Enoxaparin. Results of the Prospective BRAVE Registry with 779 Patients].
OBJECTIVE
Oral anticoagulant (OAC) therapy should be temporarily interrupted for an elective procedure or surgery, and perioperative prophylaxis with heparins should be initiated in patients who face a high or moderate risk of thrombosis. To date, the optimal heparin dose has not been established. The authors investigated the efficacy and safety of a risk-adapted regimen with the low-molecular-weight heparin enoxaparin in two different, body weight-adapted regimens.


METHODS
In the own institution, adult patients were consecutively documented in the prospective BRAVE registry, if they required bridging therapy. Patients with moderate thromboembolic risk (35.7%) received, after interruption of OAC and reaching an International Normalized Ratio (INR) of 1.5, enoxaparin 1 mg/kg body weight daily, those with high risk (64.3%) enoxaparin 1 mg/kg body weight twice daily (in case of compromised renal function half this dose, respectively). Events were recorded at 30 days post intervention by on-site examination of the patient or telephone follow-up.


RESULTS
Of 779 patients, none had a thromboembolic event. Enoxaparin was well tolerated. A total of four major bleedings in three patients (0.5%, all in the high-risk group), 46 minor bleedings (5.9%), and twelve cases of thrombocytopenia (1.5%, however, no heparin-induced thrombocytopenia [HIT] II) were noted.


CONCLUSIONS
The absence of thromboembolic events confirms the efficacy of enoxaparin in perioperative bridging. The rate of major bleedings was low and, of note, no cases of HIT II were noted. Reducing the dose to half the standard was shown to be effective and well tolerated in patients with moderate risk. Likewise, enoxaparin in a reduced dose can be safely used in patients with renal insufficiency who require bridging.
Omran
Heyder
H
St. Marien-Hospital, Bonn-Venusberg. Bonn. heyder.omran@marien-hospital-bonn.de
Hammerstingl
Christoph
C
Paar
W Dieter
WD
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007279:Injections, Subcutaneous; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013921:Thrombocytopenia / Q000139:chemically induced; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin