Brief Communication: Preoperative Anticoagulant Activity after Bridging Low-Molecular-Weight Heparin for Temporary Interruption of Warfarin

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Abstract

Background:

Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery.

Objective:

To determine the preoperative anticoagulant activity of LMWH following a standardized “bridging” regimen.

Design:

Prospective cohort study.

Setting:

Single university hospital.

Patients:

Consecutive patients who had warfarin therapy interrupted before an invasive procedure.

Intervention:

Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery.

Measurements:

Blood anti–factor Xa heparin levels measured shortly before surgery.

Results:

Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels.

Limitations:

The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated.

Conclusions:

Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.

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