Exclusive Low-Molecular-Weight Heparin as Bridging Anticoagulant After Mechanical Valve Replacement

Kindo, Michel; Gerelli, Sébastien; Minh, Tam Hoang; Zhang, Min; Meyer, Nicolás; Announe, Tarek; Bentz, Jonathan; Mansour, Ziad; Mommerot, Arnaud; Petit‐Eisenmann, Hélène; Kremer, Heidemarie; Collange, Olivier; Pottecher, Julien; Cristinar, Mircea; Thiranos, J.-C.; Billaud, Philippe; Mazzucotelli, Jean‐Philippe

doi:10.1016/j.athoracsur.2013.09.040

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…There were 11 studies or arms evaluating the outcomes of patients receiving OAC without bridging therapy (4222 patients) [23][24][25][27][28][29][30]33,36,38,40]. There were nine studies or arms evaluating the outcomes of patients receiving bridging therapy with UFH (3313 patients) [6,22,26,31,32,35,[39][40][41], and seven studies or arms evaluating the outcomes of patients receiving bridging therapy with LMWH (1999 patients) [32,34,37,39,40,42,43]. The studies evaluating OAC + LMWH were more recently published Only three studies used antiplatelet medication in combination with anticoagulants in their protocols: two studies added aspirin [7,44], and the other study added aspirin plus dipyridamole [45].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…S1. In some of the studies, parenteral anticoagulation was initiated on either the first or the second day following surgery [6,26,31,34,37,40,42,43], whereas in other studies therapy was initiated only at 48 h following surgery [22,32,35,39]. Some studies used early OAC [22,23,[28][29][30]34,35,38,40,42], whereas other studies used OAC only at 48 h following surgery [6,[24][25][26]32,33,36,37,39,41,43].…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Passaglia

Barros

Sousa

2015

Journal of Thrombosis and Haemostasis

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To cite this article: Passaglia LG, de Barros GM, de Sousa MR. Early postoperative bridging anticoagulation after mechanical heart valve replacement: a systematic review and meta-analysis. J Thromb Haemost 2015; 13: 1557-67.Summary. Objective: 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 the rates of bleeding and thromboembolic events among patients receiving oral anticoagulation (OAC), both with and without bridging anticoagulation therapy with unfractionated heparin (UFH) or subcutaneous low molecular weight heparin (LMWH). The studies' results were pooled via a mixed effects meta-analysis. Heterogeneity (I 2 ) and publication bias were both evaluated. Results: Twenty-three studies including 9534 patients were included. The bleeding rates were 1.8% (95% confidence interval CI 1.0-3.3) in the group receiving OAC, 2.2% (95% CI 0.9-5.3) in the OAC + UFH group, and 5.5% (95% CI 2.9-10.4) in the OAC + LMWH group (P = 0.042). The thromboembolic event rate was 2.1% (95% CI 1.5-2.9) in the group receiving OAC, as compared with 1.1% (95% CI 0.7-1.8) when the bridging therapy groups were combined as follows: OAC + UFH and OAC + LMWH (P = 0.035). Most of the analyses showed moderate heterogeneity and negative test results for publication bias. Conclusions: Bridging therapy following cardiac valve surgery was associated with a lower thromboembolic event rate, although the difference was small, with considerable overlap of the CIs. Direct comparisons are missing. Bridging therapy with UFH appears to be safe; however, this observation has a risk of bias. Early bridging therapy with LMWH appears to be associated with consistently high bleeding rates across multiple analyses. On the basis of the quality of the included studies, more trials are necessary to establish the clinical relevance of bridging therapy and the safety of LMWH.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Passaglia

Barros

Sousa

2015

Journal of Thrombosis and Haemostasis

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“…Additionally, the doses of bridging anticoagulants and the target range of bridging anticoagulation are significantly different between Chinese cardiac surgery centers and foreign centers [7,8]. At present, there is no clear Chinese guideline or consensus on bridging anticoagulation after MHVR, and few clinical studies have been conducted in Chinese patients [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of different bridging anticoagulation therapies used after mechanical heart valve replacement in Chinese patients - a prospective cohort study

Liu

Liang

et al. 2020

J Cardiothorac Surg

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Objective: To assess different bridging anticoagulation therapies early after mechanical heart valve replacement (MHVR) in Chinese patients. Methods: We performed a prospective, single-center, observational cohort study of 305 patients who underwent elective MHVR with different bridging anticoagulation regimens. Patients enrolled in the study were divided into three bridging therapy groups: the unfractionated heparin (UFH) group (n = 109), the low-molecular-weight heparin (LMWH) group (n = 97), and the UFH with sequential LMWH (UFH-LMWH) group (n = 99). All patients were followed for 4 weeks. Results: Two patients experienced thromboembolic stroke events in the UFH group. The LMWH group was associated with an increase in the incidence of bleeding events compared with the UFH group (10.3% VS 2.8%; P = 0.03). With a comparison of LMWH and UFH group in secondary endpoints, the statistical test for significance indicated a trend of reduced ICU length of stay (P = 0.08), postoperative length of stay (P = 0.08) and time of achieving target INR (P = 0.06). The creatinine level (odds ratio = 1.03; 95% confidence interval = 1.01 to 1.05; P = 0.02) and hypertension (odds ratio = 3.72; 95% confidence interval = 1.35 to 10.28; P = 0.01) were risk factors for bleeding events. Conclusion: For Chinese patients, the LMWH bridging anticoagulation presents the increased the incidence of bleeding events, but enables patients to benefit from achieving an early anticoagulation effect. Close follow-up and personalized management are required in patients with thromboembolic and bleeding risk factors. Trial registration: Chinese Clinical Trial Registry ChiCTR1800019841. Registered 2 December 2018 retrospectively.

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“…The risk of thromboembolic events is the highest in the first days after the procedure, reaching 4-8 cases per 100 patient-years [1][2][3][4][5][6][7][8]. However, the most common and life-threatening complication within the first 72 h after SVR is bleeding [1,2,[9][10][11][12], which results from procedure-related coagulopathy caused by excessive consumption of plasma coagulation factors, enhanced platelet and fibrinolytic pathways activation during cardiopulmonary bypass (CPB), as well as a prolongation of coagulation cascade related to hypothermia [1,13]. The risk of bleeding is further increased by the need for anticoagulation with unfractionated heparin (UFH) during SVR, reversal of its action with protamine sulfate, and its recirculation within 24 h after SVR [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…The European Society of Cardiology (ESC) recommends UFH as the first line prophylaxis early after SVR, while subcutaneous low molecular weight heparin (LMWH) is considered as off-label [16]. There is a growing body of evidence from observational studies that suggests that prophylaxis with LMWH after SVR is as safe and as effective as UFH while also having an advantage of easier administration [1,[9][10][11]. The optimal dosage and timing of LMWH initiation after SVR remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Low molecular weight heparin in surgical valve procedures: When and how much for an optimal prophylaxis?

Czerwińska-Jelonkiewicz¹,

Cisowski²,

Bochenek³

et al. 2013

Cardiol J.

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Background: Periprocedural antithrombotic prophylaxis in patients undergoing surgical valve procedures (SVP) is insufficiently investigated. Low molecular weight heparin (LMWH) has been considered as an alternative to unfractionated heparin (UFH). However, safety and efficacy of this prophylaxis strategy is unknown. This study aimed to investigate safety and efficacy of periprocedural LMWH prophylaxis and determine optimal dosage and timing for periprocedural cessation and initiation. Methods: The present study is a retrospective, single-center observational analysis of 388 patients who underwent SVP (valve replacement or valvuloplasty) between 2015 and 2016. In-hospital endpoints were bleeding, transfusions, reoperation due to bleeding, and thromboembolic events.

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Exclusive Low-Molecular-Weight Heparin as Bridging Anticoagulant After Mechanical Valve Replacement

Cited by 17 publications

References 18 publications

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

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

Comparison of different bridging anticoagulation therapies used after mechanical heart valve replacement in Chinese patients - a prospective cohort study

Low molecular weight heparin in surgical valve procedures: When and how much for an optimal prophylaxis?

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