Bridging with enoxaparin using a half-therapeutic dose regimen: safety and efficacy.
BACKGROUND
Low molecular weight heparin is widely used during the interruption of long-term oral anticoagulation in patients undergoing surgery. The optimal dose is still a matter of debate. The 8th ACCP Guidelines primarily recommend therapeutic-dose or low-dose low molecular weight heparin after stratification of the thromboembolic risk. We investigated the efficacy and safety of a standardized bridging therapy with enoxaparin in a half-therapeutic dose in patients with a target INR of 2,0 to 3,0.


METHODS
In our prospective registry we studied 198 consecutive patients receiving oral anticoagulant therapy with phenprocoumon and a planned surgery. Phenprocoumon was stopped 7 days before surgery and after reaching an INR less than 2,0 all patients received enoxaparin in a half-therapeutic dose (1 x 1 mg / kg body weight (bw)/day) until the day before surgery. Enoxaparin was continued with the same dose split into 2 x 0,5 mg / kg bw / day after the procedure. Phenprocoumon was resumed within day 1 to 14 after surgery depending on the bleeding risk as determined by the surgeon. All patients were followed up for 28 days after surgery.


RESULTS
Major surgery was performed in 148 patients (75 %). 175 patients (88 % of the total) had an intermediate thromboembolic risk. On average, enoxaparin was administered for 19,5 days. One patient (0,5 %) experienced arterial thrombosis after surgery, and one patient (0,5 %) required a second surgical intervention due to severe bleeding.


CONCLUSIONS
In patients receiving oral anticoagulant therapy with a target INR of 2,0-3,0 and at an intermediate risk of thromboembolic events who require interruption of oral anticoagulant therapy a half therapeutic dose of enoxaparin seems to be safe and effective for bridging.
Klamroth
Robert
R
Klinik für Innere Medizin, Angiologie Haemostaseologie und Pneumologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany. robert.klamroth@vivantes.de
Gottstein
S
S
Essers
E
E
Landgraf
H
H
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
D000925:Anticoagulants; D017984:Enoxaparin; D010644:Phenprocoumon