Bridging with enoxaparin using a half-therapeutic dose regimen: safety and efficacy.

Abstract

BACKGROUND:

Low molecular weight heparin is widely used during the interruption of long-term oral anticoagulation in patients undergoing surgery. The optimal dose is still a matter of debate. The 8th ACCP Guidelines primarily recommend therapeutic-dose or low-dose low molecular weight heparin after stratification of the thromboembolic risk. We investigated the efficacy and safety of a standardized bridging therapy with enoxaparin in a half-therapeutic dose in patients with a target INR of 2,0 to 3,0.

PATIENTS AND METHODS:

In our prospective registry we studied 198 consecutive patients receiving oral anticoagulant therapy with phenprocoumon and a planned surgery. Phenprocoumon was stopped 7 days before surgery and after reaching an INR less than 2,0 all patients received enoxaparin in a half-therapeutic dose (1 x 1 mg / kg body weight (bw)/day) until the day before surgery. Enoxaparin was continued with the same dose split into 2 x 0,5 mg / kg bw / day after the procedure. Phenprocoumon was resumed within day 1 to 14 after surgery depending on the bleeding risk as determined by the surgeon. All patients were followed up for 28 days after surgery.

RESULTS:

Major surgery was performed in 148 patients (75 %). 175 patients (88 % of the total) had an intermediate thromboembolic risk. On average, enoxaparin was administered for 19,5 days. One patient (0,5 %) experienced arterial thrombosis after surgery, and one patient (0,5 %) required a second surgical intervention due to severe bleeding.

CONCLUSIONS:

In patients receiving oral anticoagulant therapy with a target INR of 2,0-3,0 and at an intermediate risk of thromboembolic events who require interruption of oral anticoagulant therapy a half therapeutic dose of enoxaparin seems to be safe and effective for bridging.

• Authors: Robert Klamroth, S Gottstein, E Essers, H Landgraf
• Journal: VASA. Zeitschrift fur Gefasskrankheiten (Vasa) Vol. 39 Issue 3 Pg. 243-8 (Aug 2010) ISSN: 0301-1526 [Print] Switzerland
• PMID: 20737383 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Enoxaparin
• Phenprocoumon

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Blood Coagulation (drug effects)
• Blood Loss, Surgical (prevention & control)
• Enoxaparin (administration & dosage, adverse effects)
• Female
• Germany
• Hemorrhage (chemically induced)
• Humans
• International Normalized Ratio
• Male
• Middle Aged
• Phenprocoumon (administration & dosage)
• Postoperative Hemorrhage (blood, etiology, prevention & control)
• Prospective Studies
• Registries
• Risk Assessment
• Risk Factors
• Surgical Procedures, Operative (adverse effects)
• Thromboembolism (etiology, prevention & control)
• Time Factors