Perioperative medicine & outcomes
Perioperative Management of Anticoagulation in Patients With Mechanical Heart Valves
Authors' conclusion
In this retrospective cohort study, patients with MHVs experienced clinically meaningful risks of perioperative ATE and bleeding.
Study context
- Population
- Adults with left-sided aortic, mitral, or dual mechanical heart valves (MHVs) undergoing planned invasive procedures requiring vitamin K antagonist (VKA) interruption, thrombosis clinic, The Ottawa Hospital, Canada, 2016–2023613 interruptions
- Participants
- 373 adults
- Outcome
- Postoperative ATE and major bleeding
- Follow-up
- 30 days
Methodological detailssingle-centre, consecutive patients
- Single-centre
- Consecutive patients
Main finding
As reported in the abstract
Estimated risk of arterial thromboembolism (ATE)
1.5%
95% CI 0.8%–2.8%
Estimated risk of major bleeding
2.1%
95% CI 1.2%–3.6%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Values | Estimate | P value | |
|---|---|---|---|---|
| Postoperative therapeutic-dose bridging by valve positionMitral or dual vs aortic | mitral or dual 46.0% · aortic 23.6% | aOR 2.90 (95% CI 1.91–4.41) | ||
| ATE risk, omission vs use of postoperative bridgingOmission of postoperative bridging vs postoperative bridging · exploratory | omission of postoperative bridging 4.9% · postoperative bridging 0.9% | sHR 5.30 (95% CI 1.45–19.40) | P = 0.01 | |
| ATE risk, omission vs use of postoperative bridgingOmission of postoperative bridging vs postoperative bridging · landmark analysis; no longer statistically significant · exploratory | sHR 3.26 (95% CI 0.62–17.21) | |||
| 0.050.21520Ratio (log scale) |
Postoperative therapeutic-dose bridging, prior thromboembolism
| aOR (95% CI) | ||
|---|---|---|
| Prior thromboembolism | 1.91 (1.05–3.46) | |
| 0.20.5125Adjusted odds ratio (log scale) |
- Postoperative therapeutic-dose bridging by valve position: of interruptions: 99 of 215 vs 94 of 398
Clinically relevant bleeding (major bleeding + clinically relevant nonmajor bleeding (CRNMB))
- Occurred in interruptions
- 3.9% (95% CI, 2.6%-5.8%)
All-cause mortality
- Deaths
- 3 (0.5%; 95% CI, 0.2%-1.5%)
- Attributed to fatal ischemic stroke
- 1
Original publication
Perioperative Management of Anticoagulation in Patients With Mechanical Heart Valves. JAMA Netw Open. Published 1 September 2026. doi:10.
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