Anticoagulant bridging in left-sided mechanical heart valve patients

Management of two major postoperative bleeding complications after mandible reconstruction with fibula free flap in a patient under chronic warfarin treatment

“…By contrast, the interruption of warfarin in these settings may significantly increase the risk of serious vascular complications such as stroke, myocardial infarction, prosthetic valve thrombosis and pulmonary embolism [19]. Therefore, bridging with short-acting anticoagulant such as UFH or LMWH is recommended to manage the patient during the perioperative period [3,[20][21][22]. In clinical cases with high-bleeding rates (i.e.…”

“…Using general risk factors for TE, the transitory interruption of lifelong VKA therapy in MHV patients may produce not only perioperative TE events, but also gradual asymptomatic non-obstructive MHV thrombosis for several weeks or months before causing a serious clinical problem [27]. In contrast, anticoagulant bridging in left-sided MHV patients with either UFH or LMWH is associated with considerable risks of bleeding [22]. In this regard, Schulman et al reported that the onset of hemorrhagic complications and their severity is mainly correlated to the complexity of the surgical procedure [5].…”

“…As suggested in literature, we stopped the warfarin 4 days prior to surgery to allow the restoration of the clotting factor activity [29]. We indicated enoxaparin as bridging therapy because of its easy subcutaneous administration, quick transition to therapeutic range, weight-based dosing without the need of multiple coagulation tests and lower incidence of thrombocytopenia [5,20,22,27,29]. We stopped the enoxaparin 12 h before the surgery [26].…”

Effects of heparinoid bridging in patients with mechanical heart valves

“…Some characteristics of the samples differed, contributing to the heterogeneity between the studies, especially on the procedures that the patients underwent. The study by Hart et al (2017) only reported specific procedures in relation to complications, but did not provide an all-inclusive list of procedures. Won et al (2014) only studied participants who underwent dental procedures with a moderate or high risk of bleeding.…”

Mechanical Mitral Valve Thrombosis Secondary to Tinzaparin as an Anticoagulation Bridging Strategy

“…Oral vitamin K antagonists such as warfarin are used to anticoagulate MHV patients to minimize the risk of thrombosis [3]. Intravenous unfractionated heparin (UFH) and more recently subcutaneous low molecular weight heparin (LMWH) can be used to bridge patients when invasive procedures are required and anticoagulation must be stopped [3][4][5] In practice, LMWHs are increasingly used because they offer ease of administration, a better safety profile, and predictable therapeutic levels that eliminate the need for continuous monitoring which facilitates outpatient use, and they have been found to be efficacious in many studies [6][7][8]. However, there is a lack of comparative data between different LMWH subtypes and dosing regimens, and it is unknown if differences in efficacy exist.…”