Perioperative Anticoagulation in Patients With a Mechanical Heart Valve Who Are Undergoing Elective Noncardiac Surgery: Effect of bleeding risk

In: Mechanical Heart

21 Sep 2014

The effect of bleeding risk on postoperative anticoagulation preferences is summarized in Table 3. The risk of bleeding did not have a detectable effect on postoperative anticoagulation preferences, inasmuch as the proportion of respondents who preferred aggressive anticoagulant management was not significantly different in high-risk and low-risk bleeding scenarios.
The effect of TE or bleeding risk on the timing of postoperative IV heparin initiation is summarized in Table 4. Of respondents who preferred IV heparin for postoperative management, the risk of bleeding influenced whether the timing of heparin initiation after surgery was early (ie, within 12 h) or later (ie, > 12 h). There was a significantly smaller proportion of respondents who preferred early heparin initiation in high-risk bleeding scenarios compared with low-risk bleeding scenarios. The risk of TE did not have a detectable effect on the timing of heparin initiation, inasmuch as the proportion of respondents who preferred early heparin initiation was not significantly different in high-risk and low-risk TE scenarios.
Discussion
In this survey, we investigated physician preferences for perioperative anticoagulant therapy in patients with a mechanical heart valve who are undergoing elective noncardiac surgery. There are three main findings from this survey. (1) Preoperative and postoperative IV heparin was the most frequently selected anticoagulation option. (2) The risk of TE, but not the risk of bleeding, influenced the aggressiveness of anticoagulant management. (3) If IV heparin was selected, the risk of bleeding influenced the timing of heparin initiation. generic for doxycycline

Our finding that IV heparin was the most frequently selected anticoagulation option is noteworthy because the effectiveness and safety of this management approach has not been validated in clinical trials. The rationale for aggressive perioperative anticoagulation therapy with IV heparin is based on evidence from retrospective case series” and one small prospective cohort study that did not provide reliable estimates of the risks of perioperative TE and bleeding.
Table 4—Effect of TE or Bleeding Risk on the Timing of Postoperative IV Heparin Initiation

Bleeding Risk TE Risk p Value
High Low
High
Scenario 1 (n = 399)| 250 (63) 0.27
Scenario 2 (n = 287) 167 (58)
Low
Scenario 3 (n = 354) 268 (76) 0.26
Scenario 4 (n = 210) 150(71)
p Value 0.002 0.002

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