Skip to main content
Journal cover image

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).

Publication ,  Journal Article
Spyropoulos, AC; Turpie, AGG; Dunn, AS; Kaatz, S; Douketis, J; Jacobson, A; Petersen, H; REGIMEN Investigators,
Published in: Am J Cardiol
October 1, 2008

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.

Duke Scholars

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

October 1, 2008

Volume

102

Issue

7

Start / End Page

883 / 889

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Prospective Studies
  • Male
  • Logistic Models
  • Humans
  • Heparin, Low-Molecular-Weight
  • Heparin
  • Heart Valve Prosthesis
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Spyropoulos, A. C., Turpie, A. G. G., Dunn, A. S., Kaatz, S., Douketis, J., Jacobson, A., … REGIMEN Investigators, . (2008). 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). Am J Cardiol, 102(7), 883–889. https://doi.org/10.1016/j.amjcard.2008.05.042
Spyropoulos, Alex C., Alexander G. G. Turpie, Andrew S. Dunn, Scott Kaatz, James Douketis, Alan Jacobson, Hans Petersen, and Hans REGIMEN Investigators. “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).Am J Cardiol 102, no. 7 (October 1, 2008): 883–89. https://doi.org/10.1016/j.amjcard.2008.05.042.
Spyropoulos AC, Turpie AGG, Dunn AS, Kaatz S, Douketis J, Jacobson A, Petersen H, REGIMEN Investigators. 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). Am J Cardiol. 2008 Oct 1;102(7):883–889.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

October 1, 2008

Volume

102

Issue

7

Start / End Page

883 / 889

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Prospective Studies
  • Male
  • Logistic Models
  • Humans
  • Heparin, Low-Molecular-Weight
  • Heparin
  • Heart Valve Prosthesis
  • Female