In this retrospective cohort study, patients with mechanical heart valves experienced clinically meaningful 30-day risks of perioperative arterial thromboembolism (1.5%) and major bleeding (2.1%) after VKA interruption, and omission of postoperative bridging was associated with higher estimated ATE risk in exploratory analyses, though a causal protective effect of bridging was not established.
The 30-day risk of arterial thromboembolism (ATE) after VKA interruption in patients with mechanical heart valves was 1.5%.
The 30-day risk of major bleeding after VKA interruption was 2.1%.
Therapeutic-dose bridging was used preoperatively in the large majority of interruptions but postoperatively in fewer than one-third.
Mitral or dual valve position and prior thromboembolism were independently associated with higher odds of receiving postoperative therapeutic-dose bridging.
Omission of postoperative bridging was associated with a higher estimated 30-day ATE risk in primary analysis, but this association was no longer statistically significant in landmark analysis.
The authors concluded that omitting bridging in patients with mechanical heart valves should be approached cautiously pending stronger evidence.
This research examined what happens to patients with mechanical heart valves when they need to temporarily stop taking their blood thinner (warfarin or similar drugs) for a surgical or invasive procedure. Mechanical heart valves require ongoing anticoagulation to prevent dangerous blood clots, but surgery also carries bleeding risks. The study followed 373 patients through 613 such interruptions at a specialized clinic in Ottawa, Canada, between 2016 and 2023, tracking outcomes for 30 days after each procedure. The study found that both clotting and bleeding complications occurred at clinically meaningful rates: about 1 in 67 interruptions resulted in an arterial blood clot (stroke or similar event), and about 1 in 48 resulted in major bleeding. A practice called 'bridging'—using injectable blood thinners (like heparin) to fill the gap when warfarin is paused—was used before almost all procedures (84%) but only about a third of the time after procedures. Patients with valves in the mitral position or with both valves replaced, and those with a history of prior clots, were more likely to receive post-procedure bridging. When post-procedure bridging was omitted, the estimated risk of a blood clot was about five times higher, though this finding became uncertain in a more rigorous statistical analysis. This research suggests that decisions about whether to use post-operative bridging anticoagulation in mechanical heart valve patients remain complex and that omitting it may carry real risks—but the study design cannot definitively prove that bridging itself is protective. The authors caution that decisions to skip bridging in these patients should be made carefully until larger and more rigorous studies can provide clearer guidance.
Hrubesz G, Chan V, Xu Y, Potere N, Miron-Celis M, Connors J, et al.. (2026). Perioperative Management of Anticoagulation in Patients With Mechanical Heart Valves.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.32282