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Perioperative Bridging Therapy With Unfractionated Heparin or Low-Molecular-Weight Heparin in Patients With Mechanical Prosthetic Heart Valves on Long-Term Oral Anticoagulants (from the REGIMEN Registry)

Patients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis f... Full description

Journal Title: The American journal of cardiology 2008, Vol.102 (7), p.883-889
Main Author: Spyropoulos, Alex C., MD
Other Authors: Turpie, Alexander G.G., MD , Dunn, Andrew S., MD , Kaatz, Scott, DO, MSc , Douketis, James, MD , Jacobson, Alan, MD , Petersen, Hans, MS
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0002-9149
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title: Perioperative Bridging Therapy With Unfractionated Heparin or Low-Molecular-Weight Heparin in Patients With Mechanical Prosthetic Heart Valves on Long-Term Oral Anticoagulants (from the REGIMEN Registry)
format: Article
creator:
  • Spyropoulos, Alex C., MD
  • Turpie, Alexander G.G., MD
  • Dunn, Andrew S., MD
  • Kaatz, Scott, DO, MSc
  • Douketis, James, MD
  • Jacobson, Alan, MD
  • Petersen, Hans, MS
subjects:
  • Abridged Index Medicus
  • Administration, Oral
  • Aged
  • Analysis
  • Anticoagulants - administration & dosage
  • Biological and medical sciences
  • Canada
  • Cardiac patients
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular
  • Care and treatment
  • Chi-Square Distribution
  • Discriminant Analysis
  • Drug therapy
  • Elective Surgical Procedures
  • Female
  • Heart surgery
  • Heart Valve Prosthesis
  • Heparin - administration & dosage
  • Heparin, Low-Molecular-Weight - administration & dosage
  • Humans
  • Implants, Artificial
  • Logistic Models
  • Male
  • Medical equipment
  • Medical sciences
  • Molecular weight
  • Orthopedic surgery
  • Prospective Studies
  • Prosthesis
  • Registries
  • Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
  • United States
ispartof: The American journal of cardiology, 2008, Vol.102 (7), p.883-889
description: Patients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis from REGIMEN—a large, prospective, multicenter registry—compared UFH (n = 73) and LMWH (n = 172) as bridging anticoagulation in patients with mechanical heart valves on long-term OAT. Patient demographics and co-morbidities were generally similar between groups. There were more bileaflet valves in the LMWH group (67.4% vs 43.8%, p = 0.0005), but no differences in valve positions between groups. The LMWH group was less likely to undergo major surgery (33.7% vs 58.9%, p = 0.0002) and cardiothoracic surgery (7.6% vs 19.2%, p = 0.008), and to receive intraprocedural anticoagulants or thrombolytics (4.1% vs 13.7%, p = 0.007). Major adverse event rates (5.5% vs 10.3%, p = 0.23) and major bleeds (4.2% vs 8.8%, p = 0.17) were similar in the LMWH and UFH groups, respectively; 1 arterial thromboembolic event occurred in each group. More LMWH-bridged patients were treated as outpatients or discharged from the hospital in
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titlePerioperative Bridging Therapy With Unfractionated Heparin or Low-Molecular-Weight Heparin in Patients With Mechanical Prosthetic Heart Valves on Long-Term Oral Anticoagulants (from the REGIMEN Registry)
creatorSpyropoulos, Alex C., MD ; Turpie, Alexander G.G., MD ; Dunn, Andrew S., MD ; Kaatz, Scott, DO, MSc ; Douketis, James, MD ; Jacobson, Alan, MD ; Petersen, Hans, MS
creatorcontribSpyropoulos, Alex C., MD ; Turpie, Alexander G.G., MD ; Dunn, Andrew S., MD ; Kaatz, Scott, DO, MSc ; Douketis, James, MD ; Jacobson, Alan, MD ; Petersen, Hans, MS ; REGIMEN Investigators
descriptionPatients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis from REGIMEN—a large, prospective, multicenter registry—compared UFH (n = 73) and LMWH (n = 172) as bridging anticoagulation in patients with mechanical heart valves on long-term OAT. Patient demographics and co-morbidities were generally similar between groups. There were more bileaflet valves in the LMWH group (67.4% vs 43.8%, p = 0.0005), but no differences in valve positions between groups. The LMWH group was less likely to undergo major surgery (33.7% vs 58.9%, p = 0.0002) and cardiothoracic surgery (7.6% vs 19.2%, p = 0.008), and to receive intraprocedural anticoagulants or thrombolytics (4.1% vs 13.7%, p = 0.007). Major adverse event rates (5.5% vs 10.3%, p = 0.23) and major bleeds (4.2% vs 8.8%, p = 0.17) were similar in the LMWH and UFH groups, respectively; 1 arterial thromboembolic event occurred in each group. More LMWH-bridged patients were treated as outpatients or discharged from the hospital in <24 hours (68.6% vs 6.8%, p <0.0001). Multivariate logistic analysis found no significant differences in major bleeds and major composite adverse events when adjusting for cardiothoracic or major surgery between groups. In conclusion, for patients with mechanical prosthetic heart valves on long-term OAT, mostly outpatient-based LMWH bridging therapy appears to be feasible for selected procedures, is as safe as UFH, and is associated with a low arterial thromboembolic rate.
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languageeng
publisherNew York, NY: Elsevier Inc
subjectAbridged Index Medicus ; Administration, Oral ; Aged ; Analysis ; Anticoagulants - administration & dosage ; Biological and medical sciences ; Canada ; Cardiac patients ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Care and treatment ; Chi-Square Distribution ; Discriminant Analysis ; Drug therapy ; Elective Surgical Procedures ; Female ; Heart surgery ; Heart Valve Prosthesis ; Heparin - administration & dosage ; Heparin, Low-Molecular-Weight - administration & dosage ; Humans ; Implants, Artificial ; Logistic Models ; Male ; Medical equipment ; Medical sciences ; Molecular weight ; Orthopedic surgery ; Prospective Studies ; Prosthesis ; Registries ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; United States
ispartofThe American journal of cardiology, 2008, Vol.102 (7), p.883-889
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1Turpie, Alexander G.G., MD
2Dunn, Andrew S., MD
3Kaatz, Scott, DO, MSc
4Douketis, James, MD
5Jacobson, Alan, MD
6Petersen, Hans, MS
7REGIMEN Investigators
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0Perioperative Bridging Therapy With Unfractionated Heparin or Low-Molecular-Weight Heparin in Patients With Mechanical Prosthetic Heart Valves on Long-Term Oral Anticoagulants (from the REGIMEN Registry)
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addtitleAm J Cardiol
descriptionPatients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis from REGIMEN—a large, prospective, multicenter registry—compared UFH (n = 73) and LMWH (n = 172) as bridging anticoagulation in patients with mechanical heart valves on long-term OAT. Patient demographics and co-morbidities were generally similar between groups. There were more bileaflet valves in the LMWH group (67.4% vs 43.8%, p = 0.0005), but no differences in valve positions between groups. The LMWH group was less likely to undergo major surgery (33.7% vs 58.9%, p = 0.0002) and cardiothoracic surgery (7.6% vs 19.2%, p = 0.008), and to receive intraprocedural anticoagulants or thrombolytics (4.1% vs 13.7%, p = 0.007). Major adverse event rates (5.5% vs 10.3%, p = 0.23) and major bleeds (4.2% vs 8.8%, p = 0.17) were similar in the LMWH and UFH groups, respectively; 1 arterial thromboembolic event occurred in each group. More LMWH-bridged patients were treated as outpatients or discharged from the hospital in <24 hours (68.6% vs 6.8%, p <0.0001). Multivariate logistic analysis found no significant differences in major bleeds and major composite adverse events when adjusting for cardiothoracic or major surgery between groups. In conclusion, for patients with mechanical prosthetic heart valves on long-term OAT, mostly outpatient-based LMWH bridging therapy appears to be feasible for selected procedures, is as safe as UFH, and is associated with a low arterial thromboembolic rate.
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0Abridged Index Medicus
1Administration, Oral
2Aged
3Analysis
4Anticoagulants - administration & dosage
5Biological and medical sciences
6Canada
7Cardiac patients
8Cardiology
9Cardiology. Vascular system
10Cardiovascular
11Care and treatment
12Chi-Square Distribution
13Discriminant Analysis
14Drug therapy
15Elective Surgical Procedures
16Female
17Heart surgery
18Heart Valve Prosthesis
19Heparin - administration & dosage
20Heparin, Low-Molecular-Weight - administration & dosage
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22Implants, Artificial
23Logistic Models
24Male
25Medical equipment
26Medical sciences
27Molecular weight
28Orthopedic surgery
29Prospective Studies
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31Registries
32Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
33United States
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titlePerioperative Bridging Therapy With Unfractionated Heparin or Low-Molecular-Weight Heparin in Patients With Mechanical Prosthetic Heart Valves on Long-Term Oral Anticoagulants (from the REGIMEN Registry)
authorSpyropoulos, Alex C., MD ; Turpie, Alexander G.G., MD ; Dunn, Andrew S., MD ; Kaatz, Scott, DO, MSc ; Douketis, James, MD ; Jacobson, Alan, MD ; Petersen, Hans, MS
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9Cardiology. Vascular system
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abstractPatients with mechanical prosthetic heart valves require long-term oral anticoagulant therapy (OAT). During the temporary interruption of OAT, bridging anticoagulant therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended. This prespecified subgroup analysis from REGIMEN—a large, prospective, multicenter registry—compared UFH (n = 73) and LMWH (n = 172) as bridging anticoagulation in patients with mechanical heart valves on long-term OAT. Patient demographics and co-morbidities were generally similar between groups. There were more bileaflet valves in the LMWH group (67.4% vs 43.8%, p = 0.0005), but no differences in valve positions between groups. The LMWH group was less likely to undergo major surgery (33.7% vs 58.9%, p = 0.0002) and cardiothoracic surgery (7.6% vs 19.2%, p = 0.008), and to receive intraprocedural anticoagulants or thrombolytics (4.1% vs 13.7%, p = 0.007). Major adverse event rates (5.5% vs 10.3%, p = 0.23) and major bleeds (4.2% vs 8.8%, p = 0.17) were similar in the LMWH and UFH groups, respectively; 1 arterial thromboembolic event occurred in each group. More LMWH-bridged patients were treated as outpatients or discharged from the hospital in <24 hours (68.6% vs 6.8%, p <0.0001). Multivariate logistic analysis found no significant differences in major bleeds and major composite adverse events when adjusting for cardiothoracic or major surgery between groups. In conclusion, for patients with mechanical prosthetic heart valves on long-term OAT, mostly outpatient-based LMWH bridging therapy appears to be feasible for selected procedures, is as safe as UFH, and is associated with a low arterial thromboembolic rate.
copNew York, NY
pubElsevier Inc
pmid18805116
doi10.1016/j.amjcard.2008.05.042