Key result
Receiving therapeutic-dose LMWH for bridging anticoagulation was strongly associated with a pre-procedure residual anticoagulant effect compared to low-dose LMWH (30% vs 3%; OR 118.8, 95% CI 5.8-999.9).
Why the study?
Does bridging anticoagulation with LMWH result in a residual anticoagulant effect prior to surgery in patients interrupting warfarin?
Observational (n=73)
Does bridging anticoagulation with LMWH result in a residual anticoagulant effect prior to surgery in patients interrupting warfarin?
Odds Ratio: 118.8 (95% CI 5.8–999.9)
Absolute Event Rate: 30% vs 3%
Bridging with therapeutic-dose LMWH before surgery in patients interrupting warfarin is associated with a significant residual anticoagulant effect, which may have implications for perioperative bleeding risk.
Residual LMWH effect detected in 1 in 6 bridged patients before procedures; leaves open optimal last-dose timing and anti-Xa monitoring.
Bridging anticoagulation with low-molecular-weight heparin (LMWH) is common in patients who require temporary interruption of warfarin before surgery or a procedure, but whether such patients have a residual anticoagulant effect just before a procedure is not known. Consecutive patients who received bridging anticoagulation with LMWH had anti-Xa levels measured just before a procedure. The proportion of patients with a residual anticoagulant effect, defined as an anti-Xa level > or = 0.10 IU/ml, was determined. Multivariable regression analysis identified predictors of a residual anticoagulant effect, expressed as an odds ratio (OR) and corresponding 95% confidence interval (CI). A pre-procedure residual anticoagulant effect was detected in 12 of 73 (16%) patients overall, in 11 of 37 (30%) patients who received therapeutic-dose LMWH, and in 1 of 36 patients (3%) who received low-dose LMWH. Receiving therapeutic-dose LMWH (OR = 118.8; 95% CI: 5.8, 999.9), and increasing age (OR = 4.0; 95% CI: 1.3, 12.5) were predictors of a residual pre-procedure anticoagulant effect. In patients who require bridging anticoagulation with LMWH, a residual anticoagulant effect from LMWH is detected in 1 of 6 patients, and receiving therapeutic-dose LMWH is the strongest predictor of such an effect.
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Woods et al. (2005) conducted an observational in Patients requiring temporary interruption of warfarin before surgery or a procedure (n=73). Therapeutic-dose LMWH vs. Low-dose LMWH was evaluated on Residual anticoagulant effect (anti-Xa level ≥ 0.10 IU/ml just before a procedure) (OR 118.8, 95% CI 5.8-999.9). Receiving therapeutic-dose LMWH for bridging anticoagulation was strongly associated with a pre-procedure residual anticoagulant effect compared to low-dose LMWH (30% vs 3%; OR 118.8, 95% CI 5.8-999.9).
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