Comparison on efficacy and safety of different bridging anticoagulation therapies in patients undergoing mechanical heart valve replacement surgery
10.3760/cma.j.issn.0253-3758.2020.02.008
- VernacularTitle: 心脏机械瓣膜置换术后不同桥接抗凝治疗的比较
- Author:
Shidong LIU
1
;
Liang QI
2
;
Boxia LI
3
;
Xin LI
1
;
Tao FANG
1
;
Bing SONG
2
Author Information
1. First Clinical Medical College, Lanzhou University, Lanzhou 730000, China
2. Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou 730000, China
3. Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China
- Publication Type:Clinical Trail
- Keywords:
Heparin, low-molecular-weight;
Mechanical heart valve replacement;
Bridging anticoagulation
- From:
Chinese Journal of Cardiology
2020;48(2):130-135
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery.
Methods:Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies.
Results:A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events.
Conclusion:LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
