Hart E A, Jansen R, Meijs T A, Bouma B J, Riezebos R K, Tanis W, van Boven W J P, Hindori V, Wiersma N, Dessing T, Westerink J, Chamuleau S A J
University Medical Center Utrecht, Utrecht, The Netherlands.
Academic Medical Center, Amsterdam, The Netherlands.
Int J Cardiol. 2017 Apr 1;232:121-126. doi: 10.1016/j.ijcard.2017.01.042. Epub 2017 Jan 6.
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.
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.
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.
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.
在准备进行具有高出血风险的侵入性手术时，机械心脏瓣膜患者必须暂时停用抗凝治疗，通常采用静脉注射普通肝素（UFH）或皮下注射低分子肝素（LMWH）进行桥接抗凝。在本研究中，我们回顾性分析了UFH与LMWH作为左侧机械心脏瓣膜患者桥接策略的安全性。
我们在荷兰的四个外科中心进行了一项回顾性多中心研究。纳入2010年1月至2015年1月期间接受机械心脏瓣膜植入并进行桥接抗凝的患者。记录术后30天内不良事件的累积发生率。主要结局包括根据国际血栓与止血学会（ISTH）标准定义的大出血、症状性血栓栓塞和死亡率。
共纳入238例桥接抗凝事件（174例主动脉瓣、42例二尖瓣、22例主动脉瓣+二尖瓣）。UFH组大出血发生率为16例（19%），LMWH组为29例（19%）（p=0.97）。血栓栓塞发生率分别为2例（2.4%）和1例（0.6%）。UFH组死亡发生率为1例（1.2%），LMWH组为3例（1.9%）。所有出血并发症中超过50%被归类为大出血。
主动脉瓣和二尖瓣机械瓣膜患者的桥接抗凝存在相当大的风险，但UFH和LMWH策略之间没有明显差异。两种策略的血栓栓塞和死亡率均较低，绝大多数不良事件为出血。
