Perioperative Bridging Varies in Mechanical Valve Care

Patients with left-sided mechanical heart valves experienced measurable thromboembolic and bleeding risks after perioperative interruption of vitamin K antagonist therapy, according to a retrospective cohort study in JAMA Network Open.

The Ottawa Hospital cohort included 373 adults who contributed 613 interruptions for planned invasive procedures from 2016 through 2023. Therapeutic-dose bridging was used before 84.2% of procedures and after 31.5%. Therapeutic-dose postoperative bridging was more common for mitral or dual valves than for aortic valves.

Estimated 30-day risks were 1.5% (95% CI, 0.8%-2.8%) for arterial thromboembolism, 2.1% (95% CI, 1.2%-3.6%) for major bleeding, and 3.9% (95% CI, 2.6%-5.8%) for clinically relevant bleeding. Three deaths occurred, including one fatal ischemic stroke.

Omission of postoperative bridging was associated with higher estimated thromboembolic risk in an exploratory analysis, 4.9% versus 0.9%. However, the association was no longer statistically significant in a landmark analysis, and the confidence interval was wide.

The investigators said the data do not establish a causal protective effect of bridging. They cited possible confounding by indication, uncommon events, potential immortal-time bias, varied bridging regimens, and the single-center design as important limitations.

Source: Hrubesz G, Chan V, Xu Y, et al. Perioperative management of anticoagulation in patients with mechanical heart valves. JAMA Netw Open. 2026;9(9):e2632282. doi:10.1001/jamanetworkopen.2026.32282