Titre du document / Document title

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

Auteur(s) / Author(s)

DOUKETIS James D. ⁽¹⁾ ; WOODS Karen ⁽¹⁾ ; FOSTER Gary A. ⁽²⁾ ; CROWTHER Mark A. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Medicine and St. Joseph's Heathcare, McMaster University, Hamilton, CANADA
⁽²⁾ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, CANADA

Résumé / Abstract

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 II of 37 (30%) patients who received therapeutic-dose LMWH, and in I 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 I of 6 patients, and receiving therapeutic-dose LMWH is the strongest predictor of such an effect.

Revue / Journal Title

Thrombosis and haemostasis   ISSN 0340-6245   CODEN THHADQ 

Source / Source

2005, vol. 94, n^o3, pp. 528-531 [4 page(s) (article)] (14 ref.)

Langue / Language

Anglais

Editeur / Publisher

Schattauer, Stuttgart, ALLEMAGNE  (1976) (Revue)

Mots-clés anglais / English Keywords

Coumarine derivatives ; Antivitamin K ; Enzyme ; Hydrolases ; Peptidases ; Serine endopeptidases ; Surgery ; Coagulation Factor Xa ; Low molecular weight heparin ; Treatment ; Anticoagulant ; Warfarin ;

Mots-clés français / French Keywords

Coumarine dérivé ; Antivitamine K ; Enzyme ; Hydrolases ; Peptidases ; Serine endopeptidases ; Chirurgie ; Coagulation Factor Xa ; Héparine bas poids moléculaire ; Traitement ; Anticoagulant ; Warfarine ;

Mots-clés espagnols / Spanish Keywords

Antivitamina K ; Enzima ; Hydrolases ; Peptidases ; Serine endopeptidases ; Cirugía ; Coagulation Factor Xa ; Heparina bajo peso molecular ; Tratamiento ; Anticoagulante ; Warfarina ;

Localisation / Location

INIST-CNRS, Cote INIST : 10255, 35400013190039.0100