Study objective: To determine physicians’
anticoagulation preferences in patients with a mechanical heart valve
who are undergoing elective surgery, and to determine the effect of
different risks of thromboembolism (TE) and postoperative bleeding on
Design: Mail survey of
physicians who prescribe anticoagulant therapy.
results: Physicians were asked to provide anticoagulation
preferences in four clinical scenarios of patients with a mechanical
heart valve who are undergoing elective surgery. Physicians were asked
to select from three preoperative anticoagulation options (two
aggressive, one less aggressive) and four postoperative anticoagulation
options (two aggressive, two less aggressive). IV heparin was the most
frequently selected anticoagulation option. Depending on the scenario,
it was preferred by 39 to 79% of respondents for preoperative
anticoagulation therapy, and by 44 to 84% of respondents for
postoperative anticoagulant therapy. The risk of TE had a strong
influence on anticoagulation preferences: more respondents preferred
aggressive anticoagulant management in high-risk compared with low-risk
TE scenarios (p < 0.001). Anticoagulation preferences were not
influenced by the risk of bleeding: the proportion of respondents who
preferred aggressive anticoagulant management did not differ in
high-risk and low-risk bleeding scenarios (p > 0.05). Of respondents
who preferred IV heparin for postoperative anticoagulation therapy, the
risk of bleeding influenced the timing of heparin initiation: fewer
respondents preferred early heparin initiation (within 12 h after
surgery) in high-risk compared with low-risk bleeding scenarios
(p < 0.01).
Conclusions: (1) Preoperative and
postoperative IV heparin were the most frequently selected
anticoagulation options. (2) The risk of TE, but not the risk of
bleeding, influenced the aggressiveness of anticoagulant management.
(3) If IV heparin was selected, the risk of bleeding influenced the
timing of heparin initiation.