Early postoperative bridging anticoagulation after mechanical heart valve replacement: a systematic review and meta-analysis.

摘要: SummaryObjective To perform a systematic review and meta-analysis of studies evaluating anticoagulation during the early postoperative period following mechanical heart valve implantation. Methods Five literature databases were searched to assess rates bleeding thromboembolic events among patients receiving oral (OAC), both with without bridging therapy unfractionated heparin (UFH) or subcutaneous low molecular weight (LMWH). The studies' results pooled via mixed effects meta-analysis. Heterogeneity (I2) publication bias evaluated. Results Twenty-three including 9534 included. 1.8% (95% confidence interval CI 1.0–3.3) in the group OAC, 2.2% (95% CI 0.9–5.3) OAC + UFH group, 5.5% (95% CI 2.9–10.4) OAC + LMWH group (P = 0.042). event rate was 2.1% (95% CI 1.5–2.9) as compared 1.1% (95% CI 0.7–1.8) when groups combined follows: (P = 0.035). Most analyses showed moderate heterogeneity negative test for bias. Conclusions Bridging cardiac surgery associated lower rate, although difference small, considerable overlap CIs. Direct comparisons are missing. Bridging UFH appears be safe; however, this observation has risk bias. Early LMWH consistently high across multiple analyses. On basis quality included studies, more trials necessary establish clinical relevance safety LMWH.