Why the study?
Perioperative interruption of VKA therapy in patients with mechanical heart valves is complex, and contemporary data to inform management are limited.
Does the omission of postoperative therapeutic-dose bridging increase the risk of arterial thromboembolism or bleeding in patients with mechanical heart valves undergoing VKA interruption?
Population
373 adults with left-sided MHVs undergoing 613 planned procedures requiring VKA interruption
Comparison
Postoperative therapeutic-dose bridging vs omission of postoperative bridging
Design
Retrospective cohort study
Follow-up
30 days
Key result
Omission of postoperative bridging in patients with mechanical heart valves was associated with a higher 30-day risk of arterial thromboembolism (4.9% vs 0.9%; sHR 5.30; 95% CI 1.45-19.40; P=.01).
Authors
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May support caution omitting postoperative bridging; leaves open need for randomized trials to guide mechanical valve management.
Cohort (n=373)
No
Does the omission of postoperative therapeutic-dose bridging increase the risk of arterial thromboembolism or bleeding in patients with mechanical heart valves undergoing VKA interruption?
Hazard Ratio: 5.3 (95% CI 1.45–19.4)
Absolute Event Rate: 4.9% vs 0.9%
p-value: p=.01
In patients with mechanical heart valves undergoing invasive procedures, omitting postoperative bridging during VKA interruption may be associated with an increased risk of arterial thromboembolism.
Hrubesz et al. (2026) conducted a cohort in Mechanical heart valves requiring VKA interruption (n=373). Omission of postoperative bridging vs. Postoperative bridging was evaluated on 30-day postoperative arterial thromboembolism (ATE) (sHR 5.30, 95% CI 1.45-19.40, p=.01). Omission of postoperative bridging in patients with mechanical heart valves was associated with a higher 30-day risk of arterial thromboembolism (4.9% vs 0.9%; sHR 5.30; 95% CI 1.45-19.40; P=.01).
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