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Can we use a low molecular weight heparin after mechanical prosthetic heart valve surgery?
Les Grands Prés, Villeneuve Saint Denis, France
Correspondence to:
Dr P Meurin, Les Grands Prés, 27 rue Sainte Christine, 77174 Villeneuve Saint Denis, France; philippemeurin@hotmail.com
| The first 150 words of the full text of this article appear below. |
The risk of thromboembolism is high during the first month after mechanical prosthetic heart valve (MPHV) surgery,1 2 particularly during the lag time before oral anticoagulant (OAC) treatment reaches effective levels. Indeed, vitamin K antagonists (VKAs) take at least 5 days theoretically—and about 2 weeks in practice3—to achieve a therapeutic international normalised ratio.
A "bridging" anticoagulant is usually prescribed to cover this period. Traditionally, the bridging agent has been unfractionated heparin (UH),4 but low molecular weight heparin (LMWH) has been used more recently.3 5 6 As there are few studies to validate the efficacy and safety of either UH or LMWH in this setting, the need for heparin remains controversial and practice guidelines are not very clear cut.1 Thus, in some centres, OAC starts with VKA monotreatment, so that bridging does not become necessary unless there is an unusual delay in achieving a therapeutic international normalised ratio.4 7 8 However, a recent survey4 confirms
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Heart 2008 94: 205-210.[Abstract] [Full Text] [PDF]
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