In patients undergoing major surgical procedures with mechanical valves, what is the anticoagulation strategy?

In patients with mechanical heart valves who are undergoing major surgical procedures, an appropriate anticoagulation strategy is crucial to prevent thromboembolic events while minimizing the risk of bleeding during and after surgery. The correct approach involves bridging anticoagulation with enoxaparin.

Mechanical valves pose a higher risk for thrombus formation, especially when the patient's anticoagulation is interrupted. Enoxaparin, a low molecular weight heparin, is often used as a bridging agent because it has a rapid onset of action and can be easily managed in terms of dosing. By initiating enoxaparin before discontinuing warfarin and continuing it around the time of surgery, the patient remains protected against thromboembolism.

After the surgery, enoxaparin can be continued until the INR is therapeutic again post-operation. This bridging strategy effectively maintains anticoagulation coverage during the high-risk period associated with the surgical procedure.

In contrast, stopping anticoagulation completely or relying solely on low-dose aspirin would leave the patient vulnerable to thromboembolic events, while continuing warfarin without the bridging strategy would increase the risk of bleeding complications during surgery. Therefore, the selection of enoxaparin as a bridging anticoagulant reflects a balanced approach to managing