Authors: Jacqueline M Schulman Ammar Majeed Eva Mattsson Sam Schulman Margareta Holmström Anna Ågren
Publish Date: 2015/04/14
Volume: 40, Issue: 4, Pages: 430-436
Abstract
Patients with mechanical heart valves MHV undergoing invasive procedures often receive periprocedural bridging with lowmolecularweight heparin LMWH The bridging strategies used in reallife 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 65year period Bridging with LMWH was used in 185 procedures in a total of 117 patients Combined pre and postoperative bridging was the most frequently employed 63 Doses of LMWH were prophylactic in 96 52 of the procedures and therapeutic in 89 48 The procedurerelated 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 highrisk surgery and more therapeutic doses 53 in lowrisk 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
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