{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:16:42Z","timestamp":1788538602086,"version":"build-2803163510"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Perioperative interruption of vitamin K antagonist (VKA) therapy in patients with mechanical heart valves (MHVs) is complex, and contemporary data to inform management are limited.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To describe perioperative anticoagulation management and to estimate 30-day risks of arterial thromboembolism (ATE) and bleeding after VKA interruption in adults with left-sided MHVs.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study included consecutive adult patients (aged \u226518 years) with left-sided aortic, mitral, or dual MHVs undergoing planned invasive procedures requiring VKA interruption from January 1, 2016, to December 31, 2023, with 30-day follow-up. The study was conducted at the thrombosis clinic at The Ottawa Hospital in Ontario, Canada.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Planned invasive procedure requiring temporary interruption of VKA therapy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were 30-day postoperative ATE and major bleeding. Secondary outcomes included clinically relevant nonmajor bleeding (CRNMB) and all-cause mortality. Major bleeding and CRNMB were defined according to the International Society on Thrombosis and Hemostasis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The cohort included 373 patients (median [IQR] age, 67 [60-73] years; 217 [58.2%] male) contributing 613 interruptions. Therapeutic-dose bridging was used preoperatively in 516 interruptions (84.2%) and postoperatively in 193 (31.5%) (99 of 215 [46.0%] in mitral or dual MHV vs 94 of 398 [23.6%] in aortic MHV interruptions). Patients with mitral or dual (vs aortic) valve position and prior thromboembolism had higher estimated odds of receiving postoperative therapeutic-dose bridging (mitral or dual vs aortic: adjusted odds ratio [aOR], 2.90; 95% CI, 1.91-4.41; prior thromboembolism: aOR, 1.91; 95% CI, 1.05-3.46). Estimated 30-day risks of ATE and major bleeding were 1.5% (95% CI, 0.8%-2.8%) and 2.1% (95% CI, 1.2%-3.6%), respectively. Clinically relevant bleeding (composite of major bleeding and CRNMB) occurred in 3.9% (95% CI, 2.6%-5.8%) of interruptions. Three deaths occurred (0.5%; 95% CI, 0.2%-1.5%), 1 attributed to fatal ischemic stroke. Omission of postoperative bridging was associated with higher estimated ATE risk (4.9% vs 0.9%; subdistribution hazard ratio [sHR], 5.30; 95% CI, 1.45-19.40;\n P<\/jats:italic>\n \u2009=\u2009.01); this finding was no longer statistically significant in landmark analysis (sHR, 3.26; 95% CI, 0.62-17.21).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this retrospective cohort study, patients with MHVs experienced clinically meaningful risks of perioperative ATE and bleeding. These data do not establish a causal protective effect of postoperative bridging. However, omitting bridging in patients with MHVs was associated with a higher estimated risk of ATE in exploratory analyses and should be approached cautiously, pending stronger evidence from representative cohorts.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.32282","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:37:11Z","timestamp":1788536231000},"page":"e2632282","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Management of Anticoagulation in Patients With Mechanical Heart Valves"],"prefix":"10.1001","volume":"9","author":[{"given":"Gabriella","family":"Hrubesz","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"The Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, 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