PMID- 24954321
OWN - NLM
STAT- MEDLINE
DCOM- 20150409
LR  - 20211021
IS  - 1976-2437 (Electronic)
IS  - 0513-5796 (Print)
IS  - 0513-5796 (Linking)
VI  - 55
IP  - 4
DP  - 2014 Jul
TI  - Safety and cost-effectiveness of bridge therapies for invasive dental procedures 
      in patients with mechanical heart valves.
PG  - 937-43
LID - 10.3349/ymj.2014.55.4.937 [doi]
AB  - PURPOSE: Bridge anticoagulation therapy is mostly utilized in patients with 
      mechanical heart valves (MHV) receiving warfarin therapy during invasive dental 
      procedures because of the risk of excessive bleeding related to highly vascular 
      supporting dental structures. Bridge therapy using low molecular weight heparin 
      may be an attractive option for invasive dental procedures; however, its safety 
      and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain. 
      MATERIALS AND METHODS: This study investigated the safety and cost-effectiveness 
      of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients 
      (57+/-11 years, 35% men) with MHV who underwent invasive dental procedures. 
      RESULTS: This study included 75 patients treated with UFH-based bridge therapy 
      (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The 
      bleeding risk of dental procedures and the incidence of clinical adverse outcomes 
      were not significantly different between the UFH group and the enoxaparin group. 
      However, total medical costs were significantly lower in the enoxaparin group 
      than in the UFH group (p<0.001). After multivariate adjustment, old age (>/=65 
      years) was significantly associated with an increased risk of total bleeding 
      independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 
      1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (beta=-0.694, p<0.001) and 
      major bleeding (beta=0.296, p=0.045) were significantly associated with the medical 
      costs within 30 days after dental procedures. CONCLUSION: Considering the benefit 
      of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH 
      for bridge therapy in patients with MHV who required invasive dental procedures.
FAU - Won, Ki-Bum
AU  - Won KB
AD  - Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. ; 
      Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
FAU - Lee, Seung-Hyun
AU  - Lee SH
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
FAU - Chang, Hyuk-Jae
AU  - Chang HJ
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea. hjchang@yuhs.ac; Severance Biomedical Science 
      Institute, Seoul, Korea.
FAU - Shim, Chi-Young
AU  - Shim CY
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
FAU - Hong, Gue-Ru
AU  - Hong GR
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
FAU - Ha, Jong-Won
AU  - Ha JW
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
FAU - Chung, Namsik
AU  - Chung N
AD  - Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College 
      of Medicine, Seoul, Korea.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Korea (South)
TA  - Yonsei Med J
JT  - Yonsei medical journal
JID - 0414003
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Dentistry, Operative/*methods
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
PMC - PMC4075397
OTO - NOTNLM
OT  - Anticoagulation
OT  - bridge therapy
OT  - dental procedure
OT  - low molecular weight heparin
OT  - mechanical heart valve
COIS- The authors have no financial conflicts of interest.
EDAT- 2014/06/24 06:00
MHDA- 2015/04/10 06:00
PMCR- 2014/07/01
CRDT- 2014/06/24 06:00
PHST- 2014/06/24 06:00 [entrez]
PHST- 2014/06/24 06:00 [pubmed]
PHST- 2015/04/10 06:00 [medline]
PHST- 2014/07/01 00:00 [pmc-release]
AID - 201407937 [pii]
AID - 10.3349/ymj.2014.55.4.937 [doi]
PST - ppublish
SO  - Yonsei Med J. 2014 Jul;55(4):937-43. doi: 10.3349/ymj.2014.55.4.937.