Abstract 11202: Enoxaparin is More Efficient Than Unfractionated Heparin Considering the Safety and Cost-effectiveness for Bridgy Therapy in Patients With Mechanical Heart Valves During Invasive Dental Procedures
Introduction: Invasive dental procedures have the risk of excessive bleeding with regard to highly vascular supporting structures in patients with mechanical heart valves (MHV) receiving warfarin therapy.
Hypothesis: Bridge therapy with low molecular weight heparin (LMWH) may be an attractive option during invasive dental procedures, but the safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain.
Methods: This study investigated the safety and cost-effectiveness of enoxaparin compared with unfractionated heparin (UFH) for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV during invasive dental procedures.
Results: This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). HAS-BLED Score was significantly higher in enoxaparin group than UFH group (1.5±1.2 vs. 1.1±1.0, p<0.018). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between UFC group and enoxaparin group. However, medical costs were significantly higher in UFC group than in enoxaparin group (p<0.001). After multivariable adjustment, old age (≥ 65 years) was associated with increased risk of total bleeding (OR, 2.51; 95% CI, 1.15[[Unable to Display Character: –]]5.48; p=0.022), and bridge therapy with enoxaparin (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) was associated with the medical costs within 30 days after dental procedures.
Conclusions: Enoxaparin may be more efficient than UFH considering the safety and cost-effectiveness for bridgy therapy in patients with MHV during invasive dental procedures.
- © 2013 by American Heart Association, Inc.