title: Strategies and outcomes of periprocedural bridging therapy with low-molecular-weight heparin in patients with mechanical heart valves.
abstract: Patients with mechanical heart valves (MHV) undergoing invasive procedures often receive periprocedural bridging with low-molecular-weight heparin (LMWH). The bridging strategies used in real-life and the predictors for bleeding and thrombosis are not well studied. We retrospectively assessed patients with MHV that underwent invasive procedures requiring vitamin K antagonist interruption and LMWH bridging. Thromboembolic and bleeding events occurring up to 30 days after the procedures were recorded. Predictors of major bleeding events (MBEs) were analyzed with logistic regression. We evaluated 547 patients with MHV who underwent 275 procedures during a 6.5-year period. Bridging with LMWH was used in 185 procedures in a total of 117 patients. Combined pre- and post-operative bridging was the most frequently employed (63 %). Doses of LMWH were prophylactic in 96 (52 %) of the procedures and therapeutic in 89 (48 %). The procedure-related bleeding risk was evaluated as high in 70 (38 %) and low in 115 (62 %) of the procedures. There was a trend to more frequent use of prophylactic doses (61 %) in high-risk surgery, and more therapeutic doses (53 %) in low-risk ones. There were 36 bleeding episodes, 21 (11 % of procedures) of which were classified as MBEs, but there were no thromboembolic events. Most MBEs (n = 14; 67 %) occurred in surgeries with high bleeding risk. In the multivariate analysis, the bleeding risk of the surgery itself was the only independent predictor for MBEs. For patients with MHV receiving perioperative bridging with LMWH, the major predictor for MBE is the bleeding risk of the surgery.
authors: Department of Medicine, Coagulation Unit, Hematology Center, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Jacqueline M
authors: JM
authors: Schulman
authors: Department of Medicine, Coagulation Unit, Hematology Center, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Ammar
authors: A
authors: Majeed
authors: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Eva
authors: E
authors: Mattsson
authors: Department of Medicine, Coagulation Unit, Hematology Center, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.|Department of Medicine, McMaster University, and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
authors: Sam
authors: S
authors: Schulman
authors: Department of Medicine, Coagulation Unit, Hematology Center, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Margareta
authors: M
authors: Holmström
authors: Department of Medicine, Coagulation Unit, Hematology Center, D1:02, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. anna.agren@karolinska.se.
authors: Anna
authors: A
authors: Ågren
mesh_terms: D000328:Adult; D000368:Aged; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: Bleeding; Bridging; Low-molecular-weight heparin; Mechanical heart valves; Surgery