Comparing perioperative heparin bridging strategies in mechanical heart valve patients undergoing surgery: A systematic review and Bayesian meta-analysis.

INTRODUCTION

Perioperative heparin bridging in surgical mechanical heart valve (MHV) patients aims to prevent thromboembolism but risks bleeding. Addressing a lack of comparative data, this study synthesizes current literature to evaluate the net clinical outcomes of bridging versus no bridging.

PURPOSE: To perform a meta-analysis providing clinically actionable estimates of the benefits and risks of perioperative bridging in surgical MHV patients.

METHODS

We systematically searched PubMed, Embase, and the Cochrane Library for studies comparing heparin bridging versus no bridging in surgical MHV patients. We used a Bayesian random-effects meta-analysis to estimate risk ratios (RRs) and 95% credible intervals (95% CrIs). Posterior probabilities were then calculated to assess the treatment benefit or harm.

RESULTS

Four studies comprising 1847 patients (64.48% bridged) met the inclusion criteria. The estimated RR for thromboembolism was 1.36 (95% CrI, 0.27 to 6.97), with only a 35.1% posterior probability of risk reduction (RR ≤ 1), suggesting no clear benefit. All-cause mortality estimates were uncertain (RR, 0.68; 95% CrI, 0.12 to 3.90). Conversely, safety endpoints yielded high probabilities of hemorrhagic complications. The RR for major bleeding was 2.04 (95% CrI, 0.81 to 5.14), carrying an 82.5% probability of clinically meaningful harm (RR > 1.33). Minor bleeding showed a similar pattern (RR, 1.53; 95% CrI, 0.61 to 3.93).

CONCLUSIONS

Routine perioperative heparin bridging in surgical MHV patients increases bleeding risk without meaningful thromboembolic benefit, supporting a shift toward selective, risk-adapted management.

REGISTRATION: PROSPERO identifier no. CRD420261359162.