Comparison of different bridging anticoagulation therapies used after mechanical heart valve replacement in Chinese patients - a prospective cohort study

作者：Boxia Li, Shidong Liu, Qi Liang, Shusen Sun, Wei Sun, Yuanmin Li, Bing Song, Xinan Wu · 发表于：Journal of Cardiothoracic Surgery · 年份：2020 · DOI：10.1186/s13019-020-1084-7 · 被引用次数：13 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Valve Diseases and Treatments、Venous Thromboembolism Diagnosis and Management

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 follo...