Comparison of different bridging anticoagulation therapies used after mechanical heart valve replacement in Chinese patients - a prospective cohort study.
J Cardiothorac Surg
; 15(1): 40, 2020 Feb 24.
Article
in En
| MEDLINE
| ID: mdl-32093747
ABSTRACT
OBJECTIVE:
To assess different bridging anticoagulation therapies early after mechanical heart valve replacement (MHVR) in Chinese patients.METHODS:
We performed a prospective, single-center, observational cohort study of 305 patients who underwent elective MHVR with different bridging anticoagulation regimens. Patients enrolled in the study were divided into three bridging therapy groups the unfractionated heparin (UFH) group (n = 109), the low-molecular-weight heparin (LMWH) group (n = 97), and the UFH with sequential LMWH (UFH-LMWH) group (n = 99). All patients were followed for 4 weeks.RESULTS:
Two patients experienced thromboembolic stroke events in the UFH group. The LMWH group was associated with an increase in the incidence of bleeding events compared with the UFH group (10.3% VS 2.8%; P = 0.03). With a comparison of LMWH and UFH group in secondary endpoints, the statistical test for significance indicated a trend of reduced ICU length of stay (P = 0.08), postoperative length of stay (P = 0.08) and time of achieving target INR (P = 0.06). The creatinine level (odds ratio = 1.03; 95% confidence interval = 1.01 to 1.05; P = 0.02) and hypertension (odds ratio = 3.72; 95% confidence interval = 1.35 to 10.28; P = 0.01) were risk factors for bleeding events.CONCLUSION:
For Chinese patients, the LMWH bridging anticoagulation presents the increased the incidence of bleeding events, but enables patients to benefit from achieving an early anticoagulation effect. Close follow-up and personalized management are required in patients with thromboembolic and bleeding risk factors. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800019841. Registered 2 December 2018 retrospectively.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Thromboembolism
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Heparin
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Heart Valve Prosthesis Implantation
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Heart Valves
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Hemorrhage
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Anticoagulants
Type of study:
Clinical_trials
/
Etiology_studies
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Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Asia
Language:
En
Journal:
J Cardiothorac Surg
Year:
2020
Type:
Article
Affiliation country:
China