title: Exclusive low-molecular-weight heparin as bridging anticoagulant after mechanical valve replacement.
abstract: BACKGROUND
  Unfractionated heparin has been the standard anticoagulant used immediately after mechanical heart valve replacement (MHVR). The purpose of this study was to assess a postoperative anticoagulation protocol with low-molecular-weight heparin (LMWH) immediately after MHVR without the use of unfractionated heparin or anti-factor Xa monitoring.
  
  
  METHODS
  We performed a prospective, single-center, observational study of 1,063 consecutive patients undergoing elective MHVR with postoperative LMWH anticoagulation treatment. The exclusion criteria were as follows: renal failure, intraaortic balloon counterpulsation, critical perioperative state, or a recent neurologic event. The postoperative anticoagulation protocol used subcutaneous enoxaparin as a bridging anticoagulant treatment beginning on the first postoperative day and continuing until vitamin K antagonist treatment was fully effective. Patients were followed for 6 weeks. The primary endpoints were the incidence of thromboembolic or major bleeding events.
  
  
  RESULTS
  Eleven (1%) thromboembolic events occurred. Ten of these events were transient or permanent strokes. Major bleeding events occurred in 44 patients (4.1%), 7 of which were observed before the enoxaparin treatment period. At the time of discharge, 570 patients (53.6%) were no longer receiving LMWH treatment due to achieving the target international normalized ratio. The mean length of hospital stay was 8.5 ± 2.9 days. There were no deaths during the 6-week follow-up period.
  
  
  CONCLUSIONS
  In our highly selected population, after MHVR, postoperative anticoagulation using LMWH is associated with a low rate of thromboembolic and major bleeding events. This large observational study demonstrates that the use of LMWH as an anticoagulant is effective and safe after MHVR.
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France. Electronic address: michel.kindo@chru-strasbourg.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Kindo
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gerelli
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Tam
authors.initials: T
authors.lastname: Hoang Minh
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Public Health, University Hospitals of Strasbourg, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Announe
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bentz
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Mansour
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mommerot
authors.affiliation: Department of Cardiology, University Hospitals of Strasbourg, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Petit-Eisenmann
authors.affiliation: Department of Cardiology, University Hospitals of Strasbourg, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Kremer
authors.affiliation: Department of Surgical Intensive Care Unit, University Hospitals of Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Collange
authors.affiliation: Department of Surgical Intensive Care Unit, University Hospitals of Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pottecher
authors.affiliation: Department of Surgical Intensive Care Unit, University Hospitals of Strasbourg, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Cristinar
authors.affiliation: Department of Surgical Intensive Care Unit, University Hospitals of Strasbourg, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Thiranos
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Billaud
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Mazzucotelli
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight