A practical approach for bridging anticoagulation after mechanical heart valve replacement.

摘要: Background and aim of the study Following mechanical heart valve replacement, patients may require a form 'bridging' anticoagulation to prevent valve-associated thromboembolism until oral vitamin K antagonists take effect. In 2000, present authors changed their bridging protocol fixed dose 40 mg enoxaparin twice daily (b.i.d., subcutaneous), regardless patient's body weight renal function. The was evaluate feasibility this with regards thromboembolism, hemorrhage other adverse effects. Methods Between April 2000 December 2004, total 256 consecutive who had undergone replacement were enrolled into retrospective study. All received b.i.d., subcutaneously, as for mean 6.7 days, commencing at 3.8 days (range: 2-42 days) after surgery. This approximately 55% 32-95%) recommended considered be safe in setting. Results A 18 (7%) minor bleeding events two (0.7%) arterial thromboses seen arise from previously existing high-grade (>90%) stenosis affected vessels. At discharge, all prosthetic valves showed regular, echocardiographically confirmed, follow up 38.6 8-106 days). Mitral (p = 0.005) shown significant risk factor bleeding, but not thromboembolism. None factors reached significance when testing or major thromboembolic events. Conclusion Within special setting postoperative cardiac surgery, modified appears feasible safe, efficacy equivalent that full-dose protocols reported elsewhere using either low-molecular-weight unfractionated heparin. By protocol, effort required bridge effective greatly reduced there no requirement repeated laboratory measurements adjustments. prospective multi-center should conducted confirm hypothesis first period extracorporeal circulation is different, permits use lower dose.