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Bridging Low-Molecular-Weight Heparin for Temporary Interruption of Warfarin
TO THE EDITOR:
In their recent article on preoperative anticoagulant activity of low-molecular-weight heparin (LMWH) after a standardized bridging regimen, O'Donnell and colleagues (1) indicated the following: warfarin was withheld 4 to 5 days before the planned procedure; enoxaparin, 1 mg/kg of body weight twice daily, was given to patients 3 days before surgery; and the final dose of enoxaparin was given the night before surgery. They conclude that because the mean anti–factor Xa level before surgery was 0.6 U/mL and anti-Xa levels were 0.5 U/mL or greater in 68% of the patients, preoperative bridging therapy will result in a high residual anti-Xa level if the last dose is given the evening before surgery. They recommend that if a twice-daily regimen of LMWH is used, the …
