P-27 Comparison of two strategies for early postoperative anticoagulation after valve replacement: a randomized trial

Abstract

Although the need for anticoagulant therapy in patients with mechanical valves is not in dispute [1Vahania A. Baumgaratner H. Bax J. et al.Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology.European Heart Journal. 2007; 28: 230-268PubMed Google Scholar], the optimal early postoperative anticoagulation regimen after valve implantation has been a matter of debate [2Kulik A. Rubens F.D. Wells P.S. et al.Early postoperative anticoagulation after mechanical valve replacement: a systematic review.Ann Thorac Surg. 2006; 81: 770-781Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar]. The objective was to evaluate efficacy and safety of two approaches for early postoperative anticoagulation in patient after valve replacement. Two hundred patients undergoing elective valve replacement surgery were randomly assigned to 2 different treatment options: In Group 1, patients received heparin infusion (12-17 IU kg-1 h-1) started 6-8 hr after ICU admission with a target aPTT of 50-70 sec; In Group 2, patients received enoxaparin s/c (1 mg/kg, twice daily) started 6-8 hr after ICU admission. In both groups, warfarin (2.5 - 5 mg) was started since the 1st postoperative day and heparin/enoxaparin were discontinued when INR reached the target value of 2.0-3.0. The efficacy and safety of the two approaches for early postoperative anticoagulation in patient after valve replacement were estimated, Efficacy by number of thromboembolic events (according to Thromboembolic Level (TEL) [2Kulik A. Rubens F.D. Wells P.S. et al.Early postoperative anticoagulation after mechanical valve replacement: a systematic review.Ann Thorac Surg. 2006; 81: 770-781Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar]) and Safety by number of bleeding complications (according to Bleeding Level (BL) [2Kulik A. Rubens F.D. Wells P.S. et al.Early postoperative anticoagulation after mechanical valve replacement: a systematic review.Ann Thorac Surg. 2006; 81: 770-781Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar]). The coagulation state (aPTT, PT, INR, Plts, fibrinogen, RBC) was evaluated twice daily in both groups and the major complications (thromboembolic or bleeding) were noted. The study is in progress until March 2011. There is a trend towards the more efficacious and safe approach by the administration of LMWH (enoxaparin).