Enoxaparin Is Effective and Safe as Bridging Anticoagulation in Patients with a Mechanical Prosthetic Heart Valve who Require Temporary Interruption of Warfarin because of Surgery or an Invasive Procedure.
Bibliographic record
Abstract
Abstract Background: Enoxaparin is a low-molecular-weight heparin (LMWH) that is widely used in patients with an acute coronary syndrome and venous thromboembolism. However, there is concern about its use in patients with mechanical prosthetic heart valve because of recent reports of fatal TE occurring in pregnant women with a mechanical heart valve who received long-term enoxaparin, instead of warfarin, during pregnancy. Patients and Methods: We performed a prospective cohort study to assess the efficacy and safety of enoxaparin as bridging anticoagulation in a consecutive patients with a mechanical prosthetic heart valve who required temporary interruption of warfarin therapy because of an elective surgical or other invasive procedure. Patients had warfarin interruption and bridging anticoagulation based on a standardized peri-operative protocol and underwent clinical follow-up for 3 months after surgery. We determined the incidence and associated 95% confidence interval (CI) during the follow-up period for the following outcomes: major bleeding; arterial thromboembolism (stroke, rtansient ischemic attack, systemic embolism, valve thrombosis); all-cause death. Results: There were 174 patients included in this cohort (100 males; mean age: 67±10 years; mean weight: 76±16 kg; 115 with a mechanical aortic valve; 59 with a mechanical mitral valve or combined mechanical aortic and mitral valves) who received bridging anticoagulation with subcutaneous enoxaparin, 1 mg/kg twice-daily. No patient was lost to follow-up. Warfarin therapy was interrupted 5.7±2.2 days before the procedure. The mean number of doses of enoxaparin (1 mg/kg) administered before the procedure was 5.7±1.4 doses. After the procedure, warfarin was resumed on the evening or the next day after the procedure, and the mean number of doses of enoxaparin administered was 6.0±2.2 doses. After 3 months of clinical follow-up, 4 patients developed non-fatal major bleeding (2.3%; 95% CI: 0.06–5.7), 4 patients died (2.3%; 95% CI: 0.06–5.7), and 1 patient had a non-fatal stroke (0.56%; 95% CI: 0.01–3.1). There were no episodes of valve thrombosis or systemic embolism. Conclusions: Enoxaparin appears to be effective and safe as bridging anticoagulation in patients with a mechanical prosthetic heart valve who require temporary interruption of warfarin therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".