PMID- 16133889
OWN - NLM
STAT- MEDLINE
DCOM- 20051115
LR  - 20181201
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 20
IP  - 1
DP  - 2005 Aug
TI  - Low-molecular-weight-heparins as periprocedural anticoagulation for patients on 
      long-term warfarin therapy: a standardized bridging therapy protocol.
PG  - 11-6
AB  - BACKGROUND: Over 2 million patients in North America are on warfarin 
      anticoagulation therapy for prevention of thromboembolism. Suspension of warfarin 
      therapy is often required to prepare patients for invasive procedures or 
      surgeries. To protect these patients against thromboembolism while they are off 
      warfarin, shorter-acting parenteral agents such as low-molecular-weight heparins 
      (LMWHs) are often used. We conducted a retrospective observational study of our 
      anticoagulation clinic patients to assess the safety and efficacy of LMWHs using 
      a standardized protocol for periprocedural anticoagulation therapy. METHODS: We 
      included 69 consecutive patients who required interruption of their long-term 
      warfarin therapy between August 2001 and August 2002, and were deemed by the 
      treating physician to be at high enough risk for perioperative thromboembolism to 
      justify bridging anticoagulation. We used a standard bridging therapy protocol in 
      our anticoagulation clinic. Sixty-six patients received enoxaparin and three 
      patients received tinzaparin for a mean duration of 7.7 days postoperatively. 
      Outcomes were assessed for 30 days post-procedure. Safety outcomes included major 
      bleeding and minor bleeding. Efficacy outcomes included thromboembolic event or 
      death. RESULTS: There were two major bleeding events, one minor bleeding event, 
      and no cases of thromboembolism. Twelve patients experienced some bruising around 
      the injection site. CONCLUSIONS: LMWH administration using our standard 
      outpatient bridging protocol for perioperative anticoagulation appears to be 
      relatively safe and efficacious, offering an alternative to inpatient 
      administration of intravenous unfractionated heparin (UFH). Our study provides 
      additional evidence to the limited published observational data regarding the 
      safety and efficacy of LMWH as bridging therapy in the perioperative and 
      periprocedural setting. Large, multicenter, randomized controlled trials are 
      necessary to fully assess the safety and efficacy of LMWH for perioperative 
      anticoagulation.We conducted a retrospective observational study of 69 
      consecutive anticoagulation clinic patients on warfarin between August 2001 and 
      August 2002, who were undergoing a procedure or surgery. The study was done to 
      assess the safety and efficacy of an outpatient LMWH bridging protocol. Sixty-six 
      patients received enoxaparin and three patients received tinzaparin for a mean 
      duration of 3 days preoperatively and 7.7 days postoperatively. Outcomes were 
      assessed for 30 days post-procedure. Safety outcomes included major bleeding and 
      minor bleeding. Efficacy outcomes included thromboembolic event or death. There 
      were two major bleeding events, one minor bleeding event, and no cases of 
      thromboembolism. Twelve patients experienced some bruising around the injection 
      site.
FAU - Jaffer, Amir K
AU  - Jaffer AK
AD  - Section of Hospital Medicine, IMPACT Investigators Group, Cleveland Clinic 
      Foundation, 9500 Euclid Ave, Desk A72, Clevaland 44195, OH, USA. jaffera@ccf.org
FAU - Ahmed, Mudassar
AU  - Ahmed M
FAU - Brotman, Daniel J
AU  - Brotman DJ
FAU - Bragg, Lee
AU  - Bragg L
FAU - Seshadri, Niranjan
AU  - Seshadri N
FAU - Qadeer, Mohammed A
AU  - Qadeer MA
FAU - Klein, Allan
AU  - Klein A
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 7UQ7X4Y489 (Tinzaparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Atrial Fibrillation/drug therapy
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Hemorrhage/etiology
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Retrospective Studies
MH  - Stroke/epidemiology
MH  - Thromboembolism/prevention & control
MH  - Tinzaparin
MH  - Warfarin/*therapeutic use
EDAT- 2005/09/01 09:00
MHDA- 2005/11/16 09:00
CRDT- 2005/09/01 09:00
PHST- 2005/09/01 09:00 [pubmed]
PHST- 2005/11/16 09:00 [medline]
PHST- 2005/09/01 09:00 [entrez]
AID - 10.1007/s11239-005-3120-9 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2005 Aug;20(1):11-6. doi: 10.1007/s11239-005-3120-9.