NEW YORK (Reuters Health) – There does not appear to be a benefit to postoperative heparin bridging in patients with atrial fibrillation or a mechanical heart valve who temporarily stop taking warfarin before a planned procedure, according to results of the PERIOP2 study.
“Uncertainty remains as to whether patients with atrial fibrillation or mechanical heart valves who require interruption of vitamin K antagonists for invasive procedures benefit from bridging with low molecular weight heparin (LMWH) after the procedure,” Dr. Michael Kovacs of Western University, in London, Canada, and colleagues note in the The BMJ.
To investigate, the PERIOP2 study investigators enrolled 1,471 patients with atrial fibrillation or mechanical valves who had to stop warfarin for a procedure. They random assigned 821 to take the LMWH dalteparin and 650 to take a placebo after the procedure.
The rate of major thromboembolism within 90 days was not significantly different in the placebo and dalteparin groups (1.2% and 1.0%, respectively).
There was also no significant difference in the rate of major bleeding in the placebo and dalteparin groups (2.0% and 1.3%, respectively).
The results were consistent in patients with atrial fibrillation or a mechanical heart valve.
“Postoperative bridging with dalteparin is not beneficial in preventing major thromboembolism in patients with atrial fibrillation or mechanical heart valves (with or without atrial fibrillation) who are managed with warfarin,” the team concludes.
“Although warfarin is being used less frequently in patients with atrial fibrillation, it is still the long term anticoagulant of choice for patients with mechanical heart valves and in other populations, such as patients receiving dialysis, those with limited supply of direct oral anticoagulants, and in resource constrained settings. Our results are important for such patients. Further studies are needed to determine the need for bridging before procedures in patients with mechanical heart valves,” they add.
SOURCE: https://bit.ly/2Tzrgec The BMJ, online June 9, 2021.