PMID- 18805116 OWN - NLM STAT- MEDLINE DCOM- 20081104 LR - 20220309 IS - 0002-9149 (Print) IS - 0002-9149 (Linking) VI - 102 IP - 7 DP - 2008 Oct 1 TI - 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). PG - 883-9 LID - 10.1016/j.amjcard.2008.05.042 [doi] AB - 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. FAU - Spyropoulos, Alex C AU - Spyropoulos AC AD - Lovelace Medical Center, Albuquerque, New Mexico, USA. alex.spyropoulos@abqhp.com FAU - Turpie, Alexander G G AU - Turpie AG FAU - Dunn, Andrew S AU - Dunn AS FAU - Kaatz, Scott AU - Kaatz S FAU - Douketis, James AU - Douketis J FAU - Jacobson, Alan AU - Jacobson A FAU - Petersen, Hans AU - Petersen H CN - REGIMEN Investigators LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20080731 PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) RN - 9005-49-6 (Heparin) SB - IM MH - Administration, Oral MH - Aged MH - Anticoagulants/*administration & dosage MH - Canada MH - Chi-Square Distribution MH - Discriminant Analysis MH - *Elective Surgical Procedures MH - Female MH - *Heart Valve Prosthesis MH - Heparin/*administration & dosage MH - Heparin, Low-Molecular-Weight/administration & dosage MH - Humans MH - Logistic Models MH - Male MH - Prospective Studies MH - Registries MH - United States FIR - Spyropoulos, Alex IR - Spyropoulos A FIR - Dunn, Andrew IR - Dunn A FIR - Turpie, Alexander Graham IR - Turpie AG FIR - Spandorfer, John IR - Spandorfer J FIR - Douketis, Jim IR - Douketis J FIR - Jacobson, Alan IR - Jacobson A FIR - Spyropoulos, Alex IR - Spyropoulos A FIR - West, Mike IR - West M FIR - Dunn, Andrew IR - Dunn A FIR - Green, David IR - Green D FIR - Turpie, Alexander Graham IR - Turpie AG FIR - Spandorfer, John IR - Spandorfer J FIR - Campbell, Mark IR - Campbell M FIR - Krasuski, Richard IR - Krasuski R FIR - O'Shea, Susan IR - O'Shea S FIR - Deitelzweig, Steven IR - Deitelzweig S FIR - Muntz, Jim IR - Muntz J FIR - Kovacs, Mike IR - Kovacs M FIR - Spencer, Fred IR - Spencer F FIR - Jacobson, Alan IR - Jacobson A FIR - Jafri, Syed IR - Jafri S FIR - Kaatz, Scott IR - Kaatz S FIR - Kouketis, Jim IR - Kouketis J EDAT- 2008/09/23 09:00 MHDA- 2008/11/05 09:00 CRDT- 2008/09/23 09:00 PHST- 2008/02/15 00:00 [received] PHST- 2008/05/16 00:00 [revised] PHST- 2008/05/16 00:00 [accepted] PHST- 2008/09/23 09:00 [pubmed] PHST- 2008/11/05 09:00 [medline] PHST- 2008/09/23 09:00 [entrez] AID - S0002-9149(08)00951-X [pii] AID - 10.1016/j.amjcard.2008.05.042 [doi] PST - ppublish SO - Am J Cardiol. 2008 Oct 1;102(7):883-9. doi: 10.1016/j.amjcard.2008.05.042. Epub 2008 Jul 31.