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Early postoperative bridging anticoagulation after mechanical heart valve replacement: a systematic review and meta-analysis.
J Thromb Haemost. 2015 Jul 14;
Authors: Passaglia LG, de Barros GM, de Sousa MR
Abstract
OBJECTIVE: To perform a systematic review and meta-analysis of studies evaluating anticoagulation during the early postoperative period following mechanical heart valve implantation.
METHODS: Five literature databases were searched to assess the rates of bleeding and thromboembolic events among patients receiving oral anticoagulation (OAC), both with and without bridging anticoagulation therapy with unfractionated heparin (UFH) or subcutaneous low molecular weight heparin (LMWH). The studies' results were pooled via a mixed effects meta-analysis. Heterogeneity (I(2) ) and publication bias were both evaluated.
RESULTS: Twenty-three studies including 9534 patients were included. The bleeding rate was 1.8% (95%CI 1.0-3.3) in the group receiving OAC, 2.2% (95%CI 0.9-5.3) in the OAC+UFH group and 5.5% (95%CI 2.9-10.4) in the OAC+LMWH group (p=0.042). The thromboembolic event rate was 2.1% (95%CI 1.5-2.9) in the group receiving OAC compared with 1.1% (95%CI 0.7-1.8) when combining the bridging therapy groups as follows: OAC+UFH and OAC+LMWH (p=0.035). Most of the analyses exhibited moderate heterogeneity and negative tests for publication bias.
CONCLUSIONS: Bridging therapy following cardiac valve surgery was associated with a lower thromboembolic event rate, although the difference was small, with considerable overlap of the confidence intervals. Direct comparisons are missing. Bridging therapy with UFH appears to be safe; however, this observation has a risk of bias. Early bridging therapy with LMWH appears to be associated with consistently high bleeding rates across multiple analyses. Based on the quality of the included studies, more trials are necessary to establish the clinical relevance of bridging therapy and the safety of LMWH. This article is protected by copyright. All rights reserved.
PMID: 26178802 [PubMed - as supplied by publisher]