Enoxaparin as bridging anticoagulant treatment in cardiac surgery

Objective To assess enoxaparin as bridging anticoagulant therapy in cardiac surgery. Methods Prospective registry of those patients who underwent cardiac surgery in our center between December 2003 and June 2004 and required long term anticoagulation. Subcutaneous enoxaparin was used as bridging anticoagulant therapy according to a pre-established protocol. The global thromboembolic risk was carefully assessed in all patients. All patients were followed for 3 months. Results Of 140 patients who were included (mean age 66±11; 49 % females), 51 were already on long-term acenocumarol therapy prior the index intervention. 50% of the patients were at high or very high risk for thromboemboembolic events in the postoperative period. The mean number of days between surgery and the first dose of anticoagulant was 2.01 (SD 7) for acenocumarol and 1 (SD 1.01) for enoxaparin. The mean daily dose of enoxaparin was 1.1 mg/kg (SD 0.27). There were 6 thromboembolic events (4.2%; 95% CI 1.6-9.1) but only four of them were plausibly related to enoxaparin (2.8%; 95% CI 0.8-7.1). There were 6 major hemorrhagic events (4.2%; 95% CI 1.6-9.1) but only three plausibly related to enoxaparin (2.1%; 95% CI 0.4-6.1). Conclusions Our findings show a reasonable rate of adverse events using enoxaparin as bridging anticoagulant therapy in cardiac surgery. Randomised studies are necessary to evaluate the real efficacy and safety of enoxaparin in this context.