PMID- 30484265
OWN - NLM
STAT- MEDLINE
DCOM- 20210817
LR  - 20230701
IS  - 1898-018X (Electronic)
IS  - 1897-5593 (Print)
IS  - 1898-018X (Linking)
VI  - 27
IP  - 5
DP  - 2020
TI  - Low molecular weight heparin in surgical valve procedures: When and how much for 
      an optimal prophylaxis?
PG  - 548-557
LID - 10.5603/CJ.a2018.0146 [doi]
AB  - BACKGROUND: Periprocedural antithrombotic prophylaxis in patients undergoing 
      surgical valve procedures (SVP) is insufficiently investigated. Low molecular 
      weight heparin (LMWH) has been considered as an alternative to unfractionated 
      heparin (UFH). However, safety and efficacy of this prophylaxis strategy is 
      unknown. This study aimed to investigate safety and efficacy of periprocedural 
      LMWH prophylaxis and determine optimal dosage and timing for periprocedural 
      cessation and initiation. METHODS: The present study is a retrospective, 
      single-center observational analysis of 388 patients who underwent SVP (valve 
      replacement or valvuloplasty) between 2015 and 2016. In-hospital endpoints were 
      bleeding, transfusions, reoperation due to bleeding, and thromboembolic events. 
      RESULTS: Giving the first dose of LMWH on the day of SVP was a risk factor for 
      bleeding (OR 1.07; 95% CI 1.04-1.10; p < 0.001), transfusions (OR 1.04; 95% CI 
      1.01-1.07; p = 0.008) and reoperation due to bleeding (OR 1.20; 95% CI 1.12-1.28; 
      p < 0.001), with > 40 mg/day as a predictor. A higher dosage of LMWH 
      premedication was an independent risk factor for bleeding (OR 1.02; 95% CI 
      1.00-1.04; p = 0.03) and transfusion (OR 1.03; 95% CI 1.01-1.05; p = 0.01), with 
      > 60 mg/day as a predictor for these events. LMWH dosed within 24 h prior to SVP 
      increased the risk of transfusion (AUC 0.636; 95% CI 0.496-0.762; p = 0.04). 
      CONCLUSIONS: Bleeding is an important early concern after surgical valve 
      procedures. Safety and efficacy of periprocedural prophylaxis with LMWH depends 
      on dosage and the timing of its administration. The most optimal periprocedural 
      prophylaxis in the SVP population appears to be LMWH in dosage of 40-60 mg/day, 
      which is recommended for deep vein thrombosis prophylaxis, ceased at least one 
      day before SVP.
FAU - Czerwinska-Jelonkiewicz, Katarzyna
AU  - Czerwinska-Jelonkiewicz K
AD  - Intensive Cardiac Care Unit, Ist Department of Cardiovascular Surgery. 
      kasia_czerwinska@vp.pl.
FAU - Cisowski, Marek
AU  - Cisowski M
AD  - Ist Department of Cardiac Surgery, American Heart of Poland Inc, Armii Krajowej 
      101, 43-316 Bielsko-Biala, Poland.
FAU - Bochenek, Andrzej
AU  - Bochenek A
AD  - Ist Department of Cardiac Surgery, American Heart of Poland Inc, Armii Krajowej 
      101, 43-316 Bielsko-Biala, Poland.
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Buszman, Piotr
AU  - Buszman P
AD  - Center for Cardiovascular Research and Development, American Heart of Poland, 
      Katowice, Poland, Poland.
FAU - Milewski, Krzysztof
AU  - Milewski K
AD  - Center for Cardiovascular Research and Development, American Heart of Poland, 
      Katowice, Poland, Poland.
FAU - Kunik, Piotr
AU  - Kunik P
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Mularska, Magdalena
AU  - Mularska M
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Kocot, Krzysztof
AU  - Kocot K
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Politowski, Piotr
AU  - Politowski P
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Braczkowski, Jakub
AU  - Braczkowski J
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Trznadel, Agata
AU  - Trznadel A
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
FAU - Aboodi, Michael S
AU  - Aboodi MS
AD  - Department of Medicine, Montefiore Medical Center, New York, United States.
FAU - Buszman, Pawel
AU  - Buszman P
AD  - Medical University of Silesia, Medykow 18, 40-752 Katowice,, Poland.
AD  - Center for Cardiovascular Research and Development, American Heart of Poland, 
      Katowice, Poland, Poland.
LA  - eng
PT  - Journal Article
DEP - 20181128
PL  - Poland
TA  - Cardiol J
JT  - Cardiology journal
JID - 101392712
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants
MH  - Female
MH  - Heparin
MH  - *Heparin, Low-Molecular-Weight
MH  - Humans
MH  - *Percutaneous Coronary Intervention
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Surgical Instruments
MH  - Ventricular Function, Left
PMC - PMC8078967
OTO - NOTNLM
OT  - antithrombotic prophylaxis
OT  - bleeding complications
OT  - surgical valve procedure
COIS- Conflict of interest: None declared
EDAT- 2018/11/30 06:00
MHDA- 2021/08/18 06:00
PMCR- 2020/11/06
CRDT- 2018/11/29 06:00
PHST- 2018/09/20 00:00 [received]
PHST- 2018/11/20 00:00 [accepted]
PHST- 2018/10/26 00:00 [revised]
PHST- 2018/11/30 06:00 [pubmed]
PHST- 2021/08/18 06:00 [medline]
PHST- 2018/11/29 06:00 [entrez]
PHST- 2020/11/06 00:00 [pmc-release]
AID - VM/OJS/J/60116 [pii]
AID - cardj-27-5-548 [pii]
AID - 10.5603/CJ.a2018.0146 [doi]
PST - ppublish
SO  - Cardiol J. 2020;27(5):548-557. doi: 10.5603/CJ.a2018.0146. Epub 2018 Nov 28.