Document Detail


Perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin in patients with mechanical prosthetic heart valves on long-term oral anticoagulants (from the REGIMEN Registry).
MedLine Citation:
PMID:  18805116     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis from REGIMEN-a large, prospective, multicenter registry-compared UFH (n = 73) and LMWH (n = 172) as bridging anticoagulation in patients with mechanical heart valves on long-term OAT. Patient demographics and co-morbidities were generally similar between groups. There were more bileaflet valves in the LMWH group (67.4% vs 43.8%, p = 0.0005), but no differences in valve positions between groups. The LMWH group was less likely to undergo major surgery (33.7% vs 58.9%, p = 0.0002) and cardiothoracic surgery (7.6% vs 19.2%, p = 0.008), and to receive intraprocedural anticoagulants or thrombolytics (4.1% vs 13.7%, p = 0.007). Major adverse event rates (5.5% vs 10.3%, p = 0.23) and major bleeds (4.2% vs 8.8%, p = 0.17) were similar in the LMWH and UFH groups, respectively; 1 arterial thromboembolic event occurred in each group. More LMWH-bridged patients were treated as outpatients or discharged from the hospital in <24 hours (68.6% vs 6.8%, p <0.0001). Multivariate logistic analysis found no significant differences in major bleeds and major composite adverse events when adjusting for cardiothoracic or major surgery between groups. In conclusion, for patients with mechanical prosthetic heart valves on long-term OAT, mostly outpatient-based LMWH bridging therapy appears to be feasible for selected procedures, is as safe as UFH, and is associated with a low arterial thromboembolic rate.
Authors:
Alex C Spyropoulos; Alexander G G Turpie; Andrew S Dunn; Scott Kaatz; James Douketis; Alan Jacobson; Hans Petersen;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2008-07-31
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  883-9     Citation Subset:  AIM; IM    
Affiliation:
Lovelace Medical Center, Albuquerque, New Mexico, USA. alex.spyropoulos@abqhp.com
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Anticoagulants / administration & dosage*
Canada
Chi-Square Distribution
Discriminant Analysis
Female
Heart Valve Prosthesis*
Heparin / administration & dosage*
Heparin, Low-Molecular-Weight / administration & dosage
Humans
Logistic Models
Male
Prospective Studies
Registries
Surgical Procedures, Elective*
United States
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin
Investigator
Investigator/Affiliation:
Alex Spyropoulos / ; Andrew Dunn / ; Alexander Graham Turpie / ; John Spandorfer / ; Jim Douketis / ; Alan Jacobson / ; Alex Spyropoulos / ; Mike West / ; Andrew Dunn / ; David Green / ; Alexander Graham Turpie / ; John Spandorfer / ; Mark Campbell / ; Richard Krasuski / ; Susan O'Shea / ; Steven Deitelzweig / ; Jim Muntz / ; Mike Kovacs / ; Fred Spencer / ; Alan Jacobson / ; Syed Jafri / ; Scott Kaatz / ; Jim Kouketis /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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