Low-Molecular-Weight Heparin as Bridging Anticoagulation During Interruption of Warfarin: Assessment of a Standardized Periprocedural Anticoagulation Regimen

Abstract

The safety and efficacy of a standardized periprocedural anticoagulation regimen with low -rnolecular-weight (LIH) heparin vvas studied n 650 cat-ients who hao eumbolic stroke, chronic atria! fibrillation, or a mechanical neart valve and required interrup ton of warfarin therapy because of an nvasive procedure. Warfarin was stopped 5 or 6 days before the procedure and NIH hepadin (subcutaneous dalteparin sodium' was begun 3 days before the procedure, Patients who had a procedure considered at low risk of bleeding and whose postprocedural hemostas:s was adequate resumed warfarin on the everrng of the procedure and dalteparin was resumed the Fext itay. Dalteparin was delayed if hemostasis was unstab e. Patients wino underwent a procedure at high risk of bleeding resurned warfarin or, the evening of the procedure but dalteparin was not given after the procedure. In 542 patients who underwernt a procedure at low risk for bleeding, 2 thromboermiulic events, 4 mrajor bleeding episodes, and 32 episodes of rncreased woulo-related blood loss occurred. In 108 patients who irder.vent a procedure at nigh risk for bleeding, 2 deaths and 2n rajor bleeding episodes occurred. The authors concluded that oatients at Increased risk for arterial thromboembalism a nd vho require temporary interruption of warfarin theray, J1VlH heparin was associated with a low risk of thromboernciiC and maior bleeding complications.