Patients requiring interruption of long-term oral anticoagulant therapy: the use of fixed sub-therapeutic doses of low-molecular weight heparin.

Alessandra Casuccio, Sergio Siragusa, Lo Coco, Alessandra Malato, Abbene, Caramazza, Saccullo, Pizzo, Sergio Siragusa

    Research output: Contribution to journalArticle

    36 Citations (Scopus)

    Abstract

    Introduction: We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures Methodology: Pre-operatively, patients discontinued VKA 5 +/- 1days; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until surgery. Post-operatively, LMWH was reinitiated 12 hours after procedure while VKA the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) to 30 +/- 2 days post-procedure. Results: A total of 328 patients (55.4% at low-risk and 44.6% at high-risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and 225 (68.6%) non major invasive procedures. Overall, thromboembolic events occurred in 6 patients (1.8%, 95% confidence intervals 0.4 to 3.2), 5 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 7 patients (2.1%, 95 CI 0.6 to 3.6), 6 patients belonged to high-risk and 1 to low-risk group; most of events occurred in high-risk group during major surgery. Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patients.
    Original languageEnglish
    Pages (from-to)107-113
    Number of pages7
    JournalJournal of Thrombosis and Haemostasis
    Publication statusPublished - 2010

    Fingerprint

    Low Molecular Weight Heparin
    Anticoagulants
    Thrombosis
    Therapeutics
    Heparin
    Nadroparin
    Hemorrhage
    Enoxaparin
    International Normalized Ratio
    Thromboembolism
    Inpatients
    Suspensions
    Molecular Weight
    Confidence Intervals
    Safety
    Incidence

    All Science Journal Classification (ASJC) codes

    • Hematology

    Cite this

    Patients requiring interruption of long-term oral anticoagulant therapy: the use of fixed sub-therapeutic doses of low-molecular weight heparin. / Casuccio, Alessandra; Siragusa, Sergio; Lo Coco; Malato, Alessandra; Abbene; Caramazza; Saccullo; Pizzo; Siragusa, Sergio.

    In: Journal of Thrombosis and Haemostasis, 2010, p. 107-113.

    Research output: Contribution to journalArticle

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    title = "Patients requiring interruption of long-term oral anticoagulant therapy: the use of fixed sub-therapeutic doses of low-molecular weight heparin.",
    abstract = "Introduction: We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures Methodology: Pre-operatively, patients discontinued VKA 5 +/- 1days; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until surgery. Post-operatively, LMWH was reinitiated 12 hours after procedure while VKA the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) to 30 +/- 2 days post-procedure. Results: A total of 328 patients (55.4{\%} at low-risk and 44.6{\%} at high-risk for thrombosis) were enrolled; 103 (31.4{\%}) underwent major surgery and 225 (68.6{\%}) non major invasive procedures. Overall, thromboembolic events occurred in 6 patients (1.8{\%}, 95{\%} confidence intervals 0.4 to 3.2), 5 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 7 patients (2.1{\%}, 95 CI 0.6 to 3.6), 6 patients belonged to high-risk and 1 to low-risk group; most of events occurred in high-risk group during major surgery. Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patients.",
    keywords = "Low Molecular Weight Heparin, Fixed doses, Chronic oral anticoagulation, perioperative bridging",
    author = "Alessandra Casuccio and Sergio Siragusa and {Lo Coco} and Alessandra Malato and Abbene and Caramazza and Saccullo and Pizzo and Sergio Siragusa",
    year = "2010",
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    TY - JOUR

    T1 - Patients requiring interruption of long-term oral anticoagulant therapy: the use of fixed sub-therapeutic doses of low-molecular weight heparin.

    AU - Casuccio, Alessandra

    AU - Siragusa, Sergio

    AU - Lo Coco, null

    AU - Malato, Alessandra

    AU - Abbene, null

    AU - Caramazza, null

    AU - Saccullo, null

    AU - Pizzo, null

    AU - Siragusa, Sergio

    PY - 2010

    Y1 - 2010

    N2 - Introduction: We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures Methodology: Pre-operatively, patients discontinued VKA 5 +/- 1days; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until surgery. Post-operatively, LMWH was reinitiated 12 hours after procedure while VKA the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) to 30 +/- 2 days post-procedure. Results: A total of 328 patients (55.4% at low-risk and 44.6% at high-risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and 225 (68.6%) non major invasive procedures. Overall, thromboembolic events occurred in 6 patients (1.8%, 95% confidence intervals 0.4 to 3.2), 5 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 7 patients (2.1%, 95 CI 0.6 to 3.6), 6 patients belonged to high-risk and 1 to low-risk group; most of events occurred in high-risk group during major surgery. Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patients.

    AB - Introduction: We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures Methodology: Pre-operatively, patients discontinued VKA 5 +/- 1days; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until surgery. Post-operatively, LMWH was reinitiated 12 hours after procedure while VKA the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) to 30 +/- 2 days post-procedure. Results: A total of 328 patients (55.4% at low-risk and 44.6% at high-risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and 225 (68.6%) non major invasive procedures. Overall, thromboembolic events occurred in 6 patients (1.8%, 95% confidence intervals 0.4 to 3.2), 5 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 7 patients (2.1%, 95 CI 0.6 to 3.6), 6 patients belonged to high-risk and 1 to low-risk group; most of events occurred in high-risk group during major surgery. Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patients.

    KW - Low Molecular Weight Heparin, Fixed doses, Chronic oral anticoagulation, perioperative bridging

    UR - http://hdl.handle.net/10447/50431

    M3 - Article

    SP - 107

    EP - 113

    JO - Journal of Thrombosis and Haemostasis

    JF - Journal of Thrombosis and Haemostasis

    SN - 1538-7933

    ER -