Yonsei Med J.  2014 Jul;55(4):937-943. 10.3349/ymj.2014.55.4.937.

Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

• Won KB
• Lee SH
• Chang HJ
• Shim CY
• Hong GR
• Ha JW
• Chung N

• KMID: 2130817
• DOI: http://doi.org/10.3349/ymj.2014.55.4.937

Abstract

PURPOSE
Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain.
MATERIALS AND METHODS
This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57+/-11 years, 35% men) with MHV who underwent 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%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (> or =65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (beta=-0.694, p<0.001) and major bleeding (beta=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures.
CONCLUSION
Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.

Keyword

Anticoagulation; bridge therapy; dental procedure; low molecular weight heparin; mechanical heart valve

MeSH Terms

Aged
Anticoagulants/*therapeutic use
Dentistry, Operative/*methods
Enoxaparin/therapeutic use
Female
*Heart Valve Prosthesis
Heparin, Low-Molecular-Weight/*therapeutic use
Humans
Male
Middle Aged
Anticoagulants
Enoxaparin
Heparin, Low-Molecular-Weight