Lund University, Faculty of Medicine, Lund, Sweden.
Lund University, Faculty of Medicine, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
Thromb Res. 2018 Mar;163:180-184. doi: 10.1016/j.thromres.2017.09.023. Epub 2017 Sep 23.
Mechanical heart valve (MHV) patients undergoing invasive procedures necessitating an interruption of their lifelong anticoagulant therapy, often require bridging with low-molecular weight heparin (LMWH) or unfractionated heparin. The aim of this study was to assess whether bridging MHV patients with prophylactic doses of LMWH undergoing invasive, elective procedures is a safe and effective method.
This observational cohort study included all MHV patients on vitamin K anticoagulant therapy in Malmö, registered and monitored via AuriculA (the Swedish national quality registry for atrial fibrillation and anticoagulation), between 1/1/2008 and 31/12/2011. Inclusion criteria were periprocedural bridging therapies conducted via AuriculA. Primary endpoints were mortality, thromboembolic (TE) events or major bleedings (MBE) within 30 days of bridging.
During the study period, 210 patients had undergone 434 bridging therapies managed via AuriculA; 203 due to subtherapeutic INR-values were excluded. The remaining 231 periprocedural bridging therapies were included. All were bridged with prophylactic doses of LMWH. When comparing patients with aortic and/or mitral valve replacements undergoing low- or high-risk interventions, only number of days bridged for a low-risk intervention differed significantly. Patients with a mitral or mitral and aortic valve replacement were bridged for a longer period (p=0.023). No TE events, 1 death (0.4%) and 3 MBEs (1.3%) occurred related to periprocedural bridging.
Our study shows a low rate of MBEs, deaths and no TE events when bridging MHV patients undergoing invasive, elective procedures with prophylactic doses of LMWH.
正在接受需要中断其终身抗凝治疗的侵入性程序的机械心脏瓣膜 (MHV) 患者，通常需要桥接低分子量肝素 (LMWH) 或未分级肝素。本研究的目的是评估对接受侵入性择期手术的 MHV 患者进行预防性 LMWH 桥接是否是一种安全有效的方法。
这项观察性队列研究纳入了 2008 年 1 月 1 日至 2011 年 12 月 31 日期间在马尔默接受维生素 K 抗凝治疗并通过 AuriculA（心房颤动和抗凝的瑞典国家质量登记处）登记和监测的所有 MHV 患者。纳入标准是通过 AuriculA 进行围手术期桥接治疗。主要终点是桥接后 30 天内的死亡率、血栓栓塞 (TE) 事件或大出血 (MBE)。
在研究期间，有 210 名患者接受了 434 次通过 AuriculA 管理的桥接治疗；由于 INRs 值低于治疗范围，203 名患者被排除在外。其余 231 例围手术期桥接治疗被纳入研究。所有患者均采用预防性 LMWH 桥接。当比较接受主动脉瓣和/或二尖瓣置换术且进行低风险或高风险干预的患者时，只有低风险干预的桥接天数差异有统计学意义。行二尖瓣或二尖瓣和主动脉瓣置换术的患者桥接时间更长（p=0.023）。围手术期桥接无 TE 事件、1 例死亡（0.4%）和 3 例 MBE（1.3%）发生。
我们的研究表明，在对接受侵入性择期手术的 MHV 患者进行预防性 LMWH 桥接时，MBE、死亡和 TE 事件的发生率较低。
