BACKGROUND: After mechanical heart valve replacement (MHVR), long-term use of unfractionated heparin is sometimes required because vitamin K antagonists (VKA) are temporarily contraindicated or because the time to reach the target international normalized ratio is long. The aim of this study was to investigate the feasibility of low-molecular-weight heparin treatment in these patients. METHODS AND RESULTS: This work was conducted as a prospective study. We selected all patients (n=695) who underwent MHVR and were transferred to a postoperative cardiac rehabilitation center between January 2000 and January 2005. The study focused on patients who had not yet started VKA therapy or who had a below-target international normalized ratio despite VKA therapy. Unfractionated heparin was replaced by enoxaparin (100 IU/kg BID) until VKA treatment was fully effective. Two hundred fifty patients (60+/-11 years old) were enrolled 16+/-11 days after surgery (aortic valve replacement, n=190; mitral valve replacement, n=34; double valve replacement, n=26). Of these, 50% had permanent or transient atrial fibrillation, 40% had hypertension, 13% had diabetes, and 19% had a history of cardiac surgery. The mean duration of low-molecular-weight heparin treatment was 8.3+/-6.0 days. Patients were followed for 90 days, during which there were two major and three minor bleeding episodes and one transient ischemic attack. There were no cases of valve thrombosis and no deaths. CONCLUSIONS: After MHVR, one third of patients leave the cardiac surgery unit before VKA treatment is fully effective. Bridging anticoagulation therapy with enoxaparin appears to be feasible during this high-risk period for thromboembolism and could shorten the length of hospital stay.
BACKGROUND: After mechanical heart valve replacement (MHVR), long-term use of unfractionated heparin is sometimes required because vitamin K antagonists (VKA) are temporarily contraindicated or because the time to reach the target international normalized ratio is long. The aim of this study was to investigate the feasibility of low-molecular-weight heparin treatment in these patients. METHODS AND RESULTS: This work was conducted as a prospective study. We selected all patients (n=695) who underwent MHVR and were transferred to a postoperative cardiac rehabilitation center between January 2000 and January 2005. The study focused on patients who had not yet started VKA therapy or who had a below-target international normalized ratio despite VKA therapy. Unfractionated heparin was replaced by enoxaparin (100 IU/kg BID) until VKA treatment was fully effective. Two hundred fifty patients (60+/-11 years old) were enrolled 16+/-11 days after surgery (aortic valve replacement, n=190; mitral valve replacement, n=34; double valve replacement, n=26). Of these, 50% had permanent or transient atrial fibrillation, 40% had hypertension, 13% had diabetes, and 19% had a history of cardiac surgery. The mean duration of low-molecular-weight heparin treatment was 8.3+/-6.0 days. Patients were followed for 90 days, during which there were two major and three minor bleeding episodes and one transient ischemic attack. There were no cases of valve thrombosis and no deaths. CONCLUSIONS: After MHVR, one third of patients leave the cardiac surgery unit before VKA treatment is fully effective. Bridging anticoagulation therapy with enoxaparin appears to be feasible during this high-risk period for thromboembolism and could shorten the length of hospital stay.
Authors: Herbert Watzke; Helfried Metzler; Ansgar Weltermann; Peter Marschang; Marianne Brodmann; Wilfried Lang; Ingrid Pabinger-Fasching; Elisabeth Mahla; Sibylle Kozek-Langenecker; Michael Guschmann; Kurt Huber Journal: Wien Klin Wochenschr Date: 2013-07 Impact factor: 1.704
Authors: Joji B Kuramatsu; Jochen A Sembill; Stefan T Gerner; Maximilian I Sprügel; Manuel Hagen; Sebastian S Roeder; Matthias Endres; Karl Georg Haeusler; Jan Sobesky; Johannes Schurig; Sarah Zweynert; Miriam Bauer; Peter Vajkoczy; Peter A Ringleb; Jan Purrucker; Timolaos Rizos; Jens Volkmann; Wolfgang Müllges; Peter Kraft; Anna-Lena Schubert; Frank Erbguth; Martin Nueckel; Peter D Schellinger; Jörg Glahn; Ulrich J Knappe; Gereon R Fink; Christian Dohmen; Henning Stetefeld; Anna Lena Fisse; Jens Minnerup; Georg Hagemann; Florian Rakers; Heinz Reichmann; Hauke Schneider; Sigrid Wöpking; Albert Christian Ludolph; Sebastian Stösser; Hermann Neugebauer; Joachim Röther; Peter Michels; Michael Schwarz; Gernot Reimann; Hansjörg Bäzner; Henning Schwert; Joseph Claßen; Dominik Michalski; Armin Grau; Frederick Palm; Christian Urbanek; Johannes C Wöhrle; Fahid Alshammari; Markus Horn; Dirk Bahner; Otto W Witte; Albrecht Günther; Gerhard F Hamann; Hannes Lücking; Arnd Dörfler; Stephan Achenbach; Stefan Schwab; Hagen B Huttner Journal: Eur Heart J Date: 2018-05-14 Impact factor: 29.983
Authors: Andrew M Veitch; Geoffroy Vanbiervliet; Anthony H Gershlick; Christian Boustiere; Trevor P Baglin; Lesley-Ann Smith; Franco Radaelli; Evelyn Knight; Ian M Gralnek; Cesare Hassan; Jean-Marc Dumonceau Journal: Gut Date: 2016-03 Impact factor: 23.059