Coagulation Invention Of The Postoperative Coagulation Bridging Period After Prosthetic Valve Implantation

Background:Warfarin is the most widely used anticoagulant in the prevention of thromboembolic complications after prosthetic valve implantation among treatment options, and proved to be effective.However,low-dose anticoagulation is recommended and the onset of Warfarin is slow.There is an anticoagulation bridging period(or anticoagulation window period) inevitably before INR rise to therapeutic range.In this specific period,the addition of anticoagulant intervention is controversial.Purpose:To study the effect of the addition of UFH/LMWH anticoagulant intervention for the bridging period to the incidence of thromboembolic events and the anticoagulant-related bleeding.And discuss the optimal coagulation strategy for the bridging period. Methods:Information of1600valve surgery cases including MVR,DVR,MVP with annuloplasty ring,TVP with annuloplasty ring is collected.In the postoperative anticoagulation bridging period, unfractionated heparin(UFH) or low molecular weigh heparin(LMWH) is used in900valve implantation patients(experiment group),and no additional coagulant intervention is uesd in700patients(contrast group).The incidence of thromboembolic events and the anticoagulant-related bleeding events in both groups are observed and compared to find out whether there are statistically significant results.Result:11events of thromboembolic complications in the contrast group are reported and6in the experiment group. Significant difference is shown.(P=0.044,Fisher’s exact chi-square test)4events of anticoagulant-related bleeding are reported in the contrast group and5in the experiment group.No difference is shown.(P=0.26,Fisher’s exact chi-square test)Conclusion:The additional invention of coagulation bridging period with unfractionated heparin(UFH) or low molecular weigh heparin(LMWH) can reduce the incidence of postoperative thromboembolic events and do not increase the risk of bleeding.