Key result
Full perioperative LMWH bridging is linked to ~3% major bleeding without thromboembolic benefit vs no bridging.
Why the study?
The benefit-risk balance of perioperative LMWH bridging in patients with bileaflet mechanical aortic valves undergoing elective procedures is uncertain, as it may increase bleeding risk without a proven efficacy benefit.
Does perioperative LMWH bridging prevent thromboembolism or increase bleeding risk in patients with bileaflet mechanical aortic valves undergoing elective procedures?
Cohort (n=553)
Yes
Does perioperative LMWH bridging prevent thromboembolism or increase bleeding risk in patients with bileaflet mechanical aortic valves undergoing elective procedures?
LMWH bridging may raise bleeding risk without reducing rare events in mechanical aortic valve patients; leaves open optimal strategy pending randomized trials.
BACKGROUND: The benefit-risk balance of perioperative low-molecular-weight heparin (LMWH) bridging in patients with bileaflet mechanical aortic valves undergoing elective procedures is uncertain. While intended to prevent thromboembolism during warfarin interruption, LMWH may increase bleeding risk without a proven efficacy benefit. OBJECTIVES: This study aimed to evaluate the rates of thromboembolism and bleeding associated with different peri-operative LMWH bridging strategies compared to no bridging in this patient population. METHODS: In a multicenter retrospective cohort study, 553 patients requiring warfarin interruption were classified into 3 main analysis groups: preoperative and postoperative LMWH (n = 232), preoperative-only LMWH (n = 81), postoperative-only LMWH (n = 33), and no bridging (n = 207). The primary efficacy outcome was arterial thromboembolism within 30 days. Primary and secondary safety outcomes were major bleeding and clinically relevant non-major bleeding. Outcomes were analyzed with multivariable logistic regression and propensity-matched comparisons. RESULTS: Thromboembolic events were rare (<0.5%) and similar across all strategies. Compared to no bridging, full bridging was associated with significantly higher rates of major bleeding (3.0% vs 0%; P = 0.018) and any clinically relevant bleeding (9.5% vs 2.0%; P < 0.01). In multivariable models, full bridging predicted bleeding, whereas preoperative-only bridging did not. In a propensity-matched analysis, full bridging remained associated with a higher risk of any clinically relevant bleeding (10.6% vs 2.4%; P < 0.01). CONCLUSIONS: Among patients with bileaflet mechanical aortic valves undergoing elective procedures, 30-day thromboembolic events were rare. Full perioperative LMWH bridging was associated with increased bleeding. While this study provides valuable real-world data, prospective clinical trials are necessary to confirm and expand upon these findings.
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Godoy et al. (2026) conducted a cohort in Bileaflet mechanical aortic valves requiring warfarin interruption for elective surgery (n=553). Perioperative low-molecular-weight heparin (LMWH) bridging vs. No bridging was evaluated on Arterial thromboembolism within 30 days. Full perioperative LMWH bridging compared to no bridging significantly increased major bleeding (3.0% vs 0%; P=0.018), while 30-day thromboembolic events were rare (<0.5%) and similar across groups.
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