PMID- 23648452
OWN - NLM
STAT- MEDLINE
DCOM- 20140127
LR  - 20130704
IS  - 1875-8622 (Electronic)
IS  - 1386-0291 (Linking)
VI  - 54
IP  - 3
DP  - 2013 Jan 1
TI  - Half-dose enoxaparin vs. full-dose enoxaparin for postoperative bridging therapy 
      in patients after cardiac surgery: which dose regimen should be preferred?
PG  - 249-58
LID - 10.3233/CH-131731 [doi]
AB  - BACKGROUND: Patients who require oral anticoagulation (OAC) after cardiac surgery 
      due to an increased risk for thromboembolic events should receive bridging 
      therapy with heparin until the INR is in a therapeutic range. For this purpose, 
      unfractionated heparin (UFH) or low molecular weight heparin (LMWH) can be used. 
      Recently published studies have demonstrated the safety and efficiency of 
      therapeutic dose LMWH as bridging anticoagulant in cardiac surgery. The present 
      study compares a full-therapeutic dose regimen with a half-therapeutic dose 
      regimen of LMWH looking for safety and efficiency. PATIENTS AND METHODS: This 
      study represents a retrospective, single-center cohort study. In a period of 19 
      months all patients in whom a postoperative bridging therapy after cardiac 
      surgery was necessary (atrial fibrillation, mechanical heart valve replacement, 
      tricuspid valve repair, intracardiac patch implantation, excision of intracardiac 
      tumors) were selected. In the first part of the study, patients received 
      full-dose (FD = 1 mg/kg bodyweight twice daily) LMWH (Enoxaparin). Analogously, 
      patients in the second part of the study were treated with half-dose (HD = 0.5 
      mg/kg bodyweight twice daily) LMWH. In case of renal insufficiency (GFR <30 
      ml/min) the dose was adjusted to one daily application. The duration of follow-up 
      was the patients' entire stay in hospital. Main outcome parameters were bleeding, 
      thromboembolic events, and death. The first dose of LMWH was given on the morning 
      of the first postoperative day, considered that the bleeding risk was acceptable. 
      OAC (Phenprocoumon) was started on the evening of the first postoperative day. 
      RESULTS: Altogether 402 out of 3133 patients met the inclusion criteria (201 
      patients in each group). Despite a reduced renal function in the HD-group (p = 
      0.002) both groups were well matched. Mortality was significantly higher in the 
      HD-group than in the FD-group (5.5% vs. 0.5%, p = 0.003) but not related to the 
      anticoagulation regimen. We observed more bleeding events in the FD-group (11 vs. 
      5, p = 0.126) but vice versa more thromboembolic events in the HD-group (9 vs. 5, 
      p = 0.277). In the HD-group postoperative dialysis was required more often (29 
      vs. 12, p = 0.011) and there was a higher incidence of patients who were psychic 
      disorientated (42 vs. 26, p = 0.033). The hospital stay was longer in the 
      FD-group (FD: 15.1 +/- 9.3 days, HD 12.5 +/- 8.1 days, p = 0.003). CONCLUSION: This 
      study shows that a bridging therapy with LMWH is feasible and safe no matter 
      which dose-regimen is used. The differences observed seem not to be related to 
      the anticoagulation. The decision of using a full-dose or half-dose LMWH bridging 
      regimen should be determined by the individual risk of the patient and the 
      general bleeding risk of the procedure.
FAU - Weiss, Andreas
AU  - Weiss A
AD  - Department of Cardiac Surgery, University of Technology-Dresden, Fetscherstrasse 
      76, Dresden, Germany.
FAU - Brose, Stefan
AU  - Brose S
FAU - Ploetze, Katrin
AU  - Ploetze K
FAU - Matschke, Klaus
AU  - Matschke K
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Clin Hemorheol Microcirc
JT  - Clinical hemorheology and microcirculation
JID - 9709206
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/*adverse effects/*therapeutic use
MH  - Cardiac Surgical Procedures
MH  - Enoxaparin/administration & dosage/*adverse effects/*therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Period
MH  - Retrospective Studies
EDAT- 2013/05/08 06:00
MHDA- 2014/01/28 06:00
CRDT- 2013/05/08 06:00
PHST- 2013/05/08 06:00 [entrez]
PHST- 2013/05/08 06:00 [pubmed]
PHST- 2014/01/28 06:00 [medline]
AID - C6527604X18G8127 [pii]
AID - 10.3233/CH-131731 [doi]
PST - ppublish
SO  - Clin Hemorheol Microcirc. 2013 Jan 1;54(3):249-58. doi: 10.3233/CH-131731.