PMID- 28089150
OWN - NLM
STAT- MEDLINE
DCOM- 20171127
LR  - 20171226
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 232
DP  - 2017 Apr 1
TI  - Anticoagulant bridging in left-sided mechanical heart valve patients.
PG  - 121-126
LID - S0167-5273(17)30074-8 [pii]
LID - 10.1016/j.ijcard.2017.01.042 [doi]
AB  - BACKGROUND: In preparation for an invasive procedure with a high bleeding risk, 
      patients with a mechanical heart valve temporarily have to discontinue their 
      anticoagulant therapy and are usually bridged with either intravenous 
      unfractionated heparin (UFH) or subcutaneous low-molecular-weight heparin (LMWH). 
      In this study we retrospectively analyzed the safety of UFH versus LMWH as 
      bridging strategy in left-sided mechanical heart valve patients. METHODS: We 
      performed a retrospective multicenter study in four surgical centers in The 
      Netherlands. Patients with a mechanical heart valve implantation bridged from 
      January 2010 until January 2015 were included. The cumulative incidence of 
      adverse events in the 30days following the procedure was recorded. Main outcomes 
      were major bleeding according to International Society on Thrombosis and 
      Haemostasis (ISTH) criteria, symptomatic thromboembolism, and mortality. RESULTS: 
      In total, 238 (174 aortic, 42 mitral, 22 aortic+mitral) bridging episodes were 
      included. The incidence of major bleeding was 16 (19%) events in the UFH group 
      versus 29 (19%) events in the LMWH group (p=0.97). Incidences of thromboembolism 
      were 2 (2.4%) versus 1 (0.6%). The incidence of death was 1 (1.2%) patient in the 
      UFH group versus 3 (1.9%) patients in the LMWH group. More than 50% of all 
      bleeding complications were categorized as a major bleeding. CONCLUSIONS: 
      Bridging anticoagulation in patients with aortic and mitral mechanical valves is 
      associated with considerable risk, but no difference was apparent between UFH and 
      LMWH strategy. The rate of thromboembolism and death was low with either strategy 
      and the vast majority of adverse events were bleedings.
CI  - Copyright A(c) 2017 Elsevier B.V. All rights reserved.
FAU - Hart, E A
AU  - Hart EA
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Jansen, R
AU  - Jansen R
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Meijs, T A
AU  - Meijs TA
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Bouma, B J
AU  - Bouma BJ
AD  - Academic Medical Center, Amsterdam, The Netherlands.
FAU - Riezebos, R K
AU  - Riezebos RK
AD  - Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
FAU - Tanis, W
AU  - Tanis W
AD  - Haga Ziekenhuis, The Hague, The Netherlands.
FAU - van Boven, W J P
AU  - van Boven WJ
AD  - Academic Medical Center, Amsterdam, The Netherlands.
FAU - Hindori, V
AU  - Hindori V
AD  - Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
FAU - Wiersma, N
AU  - Wiersma N
AD  - Thrombosis Center Saltro, Utrecht, The Netherlands.
FAU - Dessing, T
AU  - Dessing T
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Westerink, J
AU  - Westerink J
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Chamuleau, S A J
AU  - Chamuleau SA
AD  - University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: 
      s.a.j.chamuleau@umcutrecht.nl.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170106
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
CIN - Int J Cardiol. 2017 Jun 1;236:398. PMID: 28407980
CIN - Int J Cardiol. 2017 Jun 1;236:399. PMID: 28407981
MH  - Anticoagulants/*therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Netherlands/epidemiology
MH  - Postoperative Hemorrhage/*epidemiology
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Thromboembolism/epidemiology/*prevention & control
OTO - NOTNLM
OT  - Bleeding
OT  - Bridging
OT  - Low-molecular-weight heparin
OT  - Mechanical heart valve
OT  - Thromboembolism
OT  - Unfractionated heparin
EDAT- 2017/01/17 06:00
MHDA- 2017/11/29 06:00
CRDT- 2017/01/17 06:00
PHST- 2016/08/10 00:00 [received]
PHST- 2016/12/08 00:00 [revised]
PHST- 2017/01/04 00:00 [accepted]
PHST- 2017/01/17 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2017/01/17 06:00 [entrez]
AID - S0167-5273(17)30074-8 [pii]
AID - 10.1016/j.ijcard.2017.01.042 [doi]
PST - ppublish
SO  - Int J Cardiol. 2017 Apr 1;232:121-126. doi: 10.1016/j.ijcard.2017.01.042. Epub 
      2017 Jan 6.