PMID- 26178802
OWN - NLM
STAT- MEDLINE
DCOM- 20160706
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 13
IP  - 9
DP  - 2015 Sep
TI  - Early postoperative bridging anticoagulation after mechanical heart valve 
      replacement: a systematic review and meta-analysis.
PG  - 1557-67
LID - 10.1111/jth.13047 [doi]
AB  - OBJECTIVE: To perform a systematic review and meta-analysis of studies evaluating 
      anticoagulation during the early postoperative period following mechanical heart 
      valve implantation. METHODS: Five literature databases were searched to assess 
      the rates of bleeding and thromboembolic events among patients receiving oral 
      anticoagulation (OAC), both with and without bridging anticoagulation therapy 
      with unfractionated heparin (UFH) or subcutaneous low molecular weight heparin 
      (LMWH). The studies' results were pooled via a mixed effects meta-analysis. 
      Heterogeneity (I(2) ) and publication bias were both evaluated. RESULTS: 
      Twenty-three studies including 9534 patients were included. The bleeding rates 
      were 1.8% (95% confidence interval CI 1.0-3.3) in the group receiving OAC, 2.2% 
      (95% CI 0.9-5.3) in the OAC + UFH group, and 5.5% (95% CI 2.9-10.4) in the 
      OAC + LMWH group (P = 0.042). The thromboembolic event rate was 2.1% 
      (95% CI 1.5-2.9) in the group receiving OAC, as compared with 1.1% 
      (95% CI 0.7-1.8) when the bridging therapy groups were combined as follows: 
      OAC + UFH and OAC + LMWH (P = 0.035). Most of the analyses showed moderate 
      heterogeneity and negative test results for publication bias. CONCLUSIONS: 
      Bridging therapy following cardiac valve surgery was associated with a lower 
      thromboembolic event rate, although the difference was small, with considerable 
      overlap of the CIs. Direct comparisons are missing. Bridging therapy with UFH 
      appears to be safe; however, this observation has a risk of bias. Early bridging 
      therapy with LMWH appears to be associated with consistently high bleeding rates 
      across multiple analyses. On the basis of the quality of the included studies, 
      more trials are necessary to establish the clinical relevance of bridging therapy 
      and the safety of LMWH.
CI  - (c) 2015 International Society on Thrombosis and Haemostasis.
FAU - Passaglia, L G
AU  - Passaglia LG
AD  - School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, 
      Minas Gerais, Brazil.
AD  - Postgraduate Program in Adult Health Sciences, Hospital das Clinicas, 
      Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
FAU - de Barros, G M
AU  - de Barros GM
AD  - School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, 
      Minas Gerais, Brazil.
FAU - de Sousa, M R
AU  - de Sousa MR
AD  - School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, 
      Minas Gerais, Brazil.
AD  - Postgraduate Program in Adult Health Sciences, Hospital das Clinicas, 
      Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20150729
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Administration, Oral
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Equipment Design
MH  - Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin/administration & dosage/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse effects/therapeutic 
      use
MH  - Hospital Mortality
MH  - Humans
MH  - Postoperative Complications/*drug therapy/prevention & control
MH  - Postoperative Period
MH  - Publication Bias
MH  - Thromboembolism/epidemiology/etiology/*prevention & control
MH  - Thrombophilia/*drug therapy/etiology
MH  - Treatment Outcome
MH  - Warfarin/administration & dosage/adverse effects/therapeutic use
OTO - NOTNLM
OT  - anticoagulants
OT  - cardiac surgical procedures
OT  - heart valve diseases
OT  - heart valve prosthesis implantation
OT  - meta-analysis
EDAT- 2015/07/17 06:00
MHDA- 2016/07/07 06:00
CRDT- 2015/07/17 06:00
PHST- 2015/02/18 00:00 [received]
PHST- 2015/06/30 00:00 [accepted]
PHST- 2015/07/17 06:00 [entrez]
PHST- 2015/07/17 06:00 [pubmed]
PHST- 2016/07/07 06:00 [medline]
AID - S1538-7836(22)03439-0 [pii]
AID - 10.1111/jth.13047 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2015 Sep;13(9):1557-67. doi: 10.1111/jth.13047. Epub 2015 Jul 
      29.