Valvular & structural heart diseaseCohort study
Perioperative Heparin Bridging in Patients With Mechanical Aortic Valves Undergoing Elective Surgery
- multicenter retrospective cohort study
- multivariable logistic regression
- propensity-matched comparisons
Authors' conclusion
Among patients with bileaflet mechanical aortic valves undergoing elective procedures, 30-day thromboembolic events were rare. Full perioperative LMWH bridging was associated with increased bleeding. While this study provides valuable real-world data, prospective clinical trials are necessary to confirm and expand upon these findings.
Study context
- Population
- Patients with bileaflet mechanical aortic valves requiring warfarin interruption for elective procedurespatients requiring warfarin interruption
- Participants
- 553 patients
- Exposure
- different peri-operative low-molecular-weight heparin (LMWH) bridging strategies compared to no bridging
- full bridgingn = 232
- preoperative-only LMWHn = 81
- postoperative-only LMWHn = 33
- no bridgingn = 207
- Outcome
- Arterial thromboembolism (primary efficacy outcome)
- Follow-up
- Within 30 days
Main finding
As reported in the abstract
Thromboembolic events were rare and similar across all strategies
<0.5%
Observational data: associations, not effects.
Safety
| Outcome | full bridging | preoperative-only LMWH | postoperative-only LMWH | no bridging | P value |
|---|---|---|---|---|---|
| Major bleeding (primary safety outcome) · significantly higher with full bridging | 3.0% | Not reported in the abstract | Not reported in the abstract | 0% | P = 0.018 |
| Any clinically relevant bleeding · significantly higher with full bridging | 9.5% | Not reported in the abstract | Not reported in the abstract | 2.0% | P < 0.01 |
| Any clinically relevant bleeding, propensity-matched analysis · higher risk with full bridging · propensity-matched | 10.6% | Not reported in the abstract | Not reported in the abstract | 2.4% | P < 0.01 |
Bleeding, multivariable models
- full bridging predicted bleeding, whereas preoperative-only bridging did not
- multivariable models
Original publication
Perioperative Heparin Bridging in Patients With Mechanical Aortic Valves Undergoing Elective Surgery. JACC Adv. Published 23 January 2026. doi:10.1016/j.jacadv.2025.102578
Summarised from the published abstract; every number is checked against it