title: Bridging Anticoagulation After Mechanical Aortic Heart Valve Replacement: A Questionable Routine.
abstract: BACKGROUND
  This retrospective single-center study evaluates differences in bleeding and thrombotic events between a homogenous group of patients undergoing mechanical aortic valve replacement who either received or did not receive intravenous unfractionated heparin or subcutaneous low-molecular weight heparin as bridging strategy to warfarin therapy.
  
  
  METHODS
  Clinical data on a total of 158 patients undergoing mechanical aortic valve replacement at our center between 2001 and 2014 were collected. Patients were grouped according to postoperative anticoagulation strategy: warfarin only (n = 53) and warfarin plus heparin bridge (n = 105). The outcomes of interest were bleeding event and thromboembolic event recorded during hospital stay.
  
  
  RESULTS
  Patients' baseline characteristics were comparable between the two groups except for preoperative atrial fibrillation, which was more common in the warfarin plus heparin group than the warfarin group (p = 0.04). There were significantly more bleeding complications in the warfarin plus heparin group versus warfarin group as evidenced by higher rates of pericardial effusions (24% versus 8%, p = 0.02) and reoperation for bleeding (8% versus 0%, p = 0.05). All observed thromboembolic events (n = 4) occurred in the warfarin plus heparin group (p = 0.55). Logistic regression analysis identified group assignment (warfarin plus heparin versus warfarin only) to be significantly associated with the odds of bleeding (odds ratio 4.46, 95% confidence interval:1.42 to 14.02, p = 0.01).
  
  
  CONCLUSIONS
  Bridging anticoagulation therapy increases the chances of bleeding in the postoperative phase for mechanical aortic valve replacement patients. Owing to low incidence, no statistically significant difference was detected for thromboembolic event rates.
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Guglielmetti
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Sorabella
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Codruta
authors.initials: C
authors.lastname: Chiuzan
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Castillero
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lambert
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Min J
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: ig2006@cumc.columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin