title: Safety and cost-effectiveness of bridge therapies for invasive dental procedures in patients with mechanical heart valves.
abstract: OBJECTIVE
  Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain.
  
  
  METHODS
  This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures.
  
  
  RESULTS
  This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures.
  
  
  CONCLUSIONS
  Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.
authors: Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. ; Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Ki-Bum
authors: KB
authors: Won
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Seung-Hyun
authors: SH
authors: Lee
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea. hjchang@yuhs.ac; Severance Biomedical Science Institute, Seoul, Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Chi-Young
authors: CY
authors: Shim
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Gue-Ru
authors: GR
authors: Hong
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Jong-Won
authors: JW
authors: Ha
authors: Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
authors: Namsik
authors: N
authors: Chung
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D003814:Dentistry, Operative / Q000379:methods*; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006350:Heart Valve Prosthesis; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight
keywords: Anticoagulation; bridge therapy; dental procedure; low molecular weight heparin; mechanical heart valve