Patients requiring interruption of long‐term oral anticoagulant therapy: the use of fixed sub‐therapeutic doses of low‐molecular‐weight heparin

Introduction: We tested the efficacy and safety of fixed doses of low‐molecular‐weight heparin (LMWH) in patients requiring interruption of vitamin‐K antagonist (VKA) because of invasive procedures. Methodology: Preoperatively, patients discontinued VKA for 5 ± 1 days; in those at low risk for throm...

Full description

Saved in:
Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2010-01, Vol.8 (1), p.107-113
Main Authors: MALATO, A., SACCULLO, G., LO COCO, L., CARAMAZZA, D., ABBENE, I., PIZZO, G., CASUCCIO, A., SIRAGUSA, S.
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
chronic oral anticoagulation
Drug Administration Schedule
Enoxaparin - administration & dosage
Factor Xa Inhibitors
Feasibility Studies
Female
fixed doses
Heparin, Low-Molecular-Weight - administration & dosage
Heparin, Low-Molecular-Weight - adverse effects
Humans
low‐molecular‐weight heparin
Male
Middle Aged
Nadroparin - administration & dosage
perioperative bridging
Postoperative Hemorrhage - blood
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - prevention & control
Prospective Studies
Risk Assessment
Risk Factors
Surgical Procedures, Operative - adverse effects
Thromboembolism - blood
Thromboembolism - etiology
Thromboembolism - prevention & control
Time Factors
Vitamin K - antagonists & inhibitors
Warfarin - administration & dosage
Warfarin - adverse effects
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: We tested the efficacy and safety of fixed doses of low‐molecular‐weight heparin (LMWH) in patients requiring interruption of vitamin‐K antagonist (VKA) because of invasive procedures. Methodology: Preoperatively, patients discontinued VKA for 5 ± 1 days; in those at low risk for thrombosis, LMWH was given at a prophylactic dosage of 3800 UI (nadroparin) or 4000 UI (enoxaparin) anti‐factor (F) Xa once daily the night before the procedure. In patients at high risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub‐therapeutic doses (3800 or 4000 UI anti‐FXa twice daily) until surgery. Postoperatively, LMWH was reinitiated 12 h after procedure while VKA was reinitiated the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) up to 30 ± 2 days postprocedure. Results: A total of 328 patients (55.4% at low risk and 44.6% at high risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and 225 (68.6%) non‐major invasive procedures. Overall, thromboembolic events occurred in six patients (1.8%, 95% confidence interval 0.4–3.2), five belonging to the high‐risk group and one belonging to the low‐risk group. Overall, major bleeding occurred in seven patients (2.1%, 95 confidence interval 0.6–3.6), six patients belonged to the high‐risk group and one belonged to the low‐risk group; most of the events occurred in the high‐risk group during major surgery. Conclusion:  LMWH given at fixed sub‐therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patients.
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/j.1538-7836.2009.03649.x