Bridging anticoagulation with low-molecular-weight heparin after interruption of warfarin therapy is associated with a residual anticoagulant effect prior to surgery

被引:48
作者
Douketis, JD
Woods, K
Foster, GA
Crowther, M
机构
[1] McMaster Univ, Dept Med, Hamilton, ON, Canada
[2] McMaster Univ, St Josephs Heathcare, Hamilton, ON, Canada
[3] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
关键词
low-molecular-weight heparin; surgery; anti-factor Xa; warfarin;
D O I
10.1160/TH05-01-0064
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 >= 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 (Cl). 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% Cl: 5.8, 999.9), and increasing age (OR = 4.0; 95% Cl: 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.
引用
收藏
页码:528 / 531
页数:4
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