Outpatient Low-Molecular Weight Heparin Periprocedural Management as Effective as Inpatient IV Unfractionated Heparin

NEW ORLEANS, LA— Low-molecular weight heparin (LMWH) was shown to be as effective as inpatient IV unfractionated heparin (IVUH) management in mechanical heart valve (MHV) patients requiring interruption of chronic anticoagulation for an invasive procedure, reported Waldemar E. Wyoskinski, M.D., from the Mayo Clinic, Rochester, MN, and colleagues at ACC.11, the American College of Cardiology's 60th Annual Scientific Session. LMWH was also associated with less major bleeding.

In a retrospective population-based case-cohort study, Olmsted County, MN, residents with MHVs who received outpatient periprocedural LMWH management (cases) over the 7-year period of 1997 of 2003 (n=149) were matched on valve and procedure type to MHV patients who received inpatient IVUH periprocedural management (cohort) over the same timeframe. Both groups were followed via their complete medical records for thromboembolism and major bleeding within 3 months.

A reported 149 cases (100 aortic, 29 mitral, 20 both; 64% bileaflet) were compared to 149 cohort members (100 aortic, 29 mitral, 20 both; 75% bileaflet). While the 3-month cumulative incidence of thromboembolism did not differ significantly among cases (2.7%) and cohort members (cohort 4.7%; P=0.36), major bleeding was significantly lower in cases (5.4% vs. 15.4%; P<0.005).

Investigators concluded that for MHV patients requiring interruption of chronic anticoagulation for an invasive diagnostic or therapeutic procedure, outpatient LWMH periprocedural management demonstrates comparable efficacy to inpatient IVUH management and is associated with a reduced rate of major bleeding.