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September 4, 2026JAMA Network OpenOpen Access

Omitting postoperative bridging in mechanical valves is linked to ~430% higher 30-day arterial thromboembolism risk.

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Why the study?

Does the omission of postoperative therapeutic-dose bridging increase the risk of arterial thromboembolism or bleeding in patients with mechanical heart valves undergoing VKA interruption?

Population

373 consecutive adult patients with left-sided aortic, mitral, or dual mechanical heart valves undergoing…

Comparison

Temporary interruption of vitamin K antagonist… vs Omission of postoperative therapeutic-dose…

Design

Cohort

Follow-up

30-day

Key result

Omission of postoperative bridging in patients with mechanical heart valves was associated with a higher 30-day risk of arterial thromboembolism (4.9% vs 0.9%; sHR 5.30; 95% CI 1.45-19.40; P=.01).

Authors

GHGabriella HrubeszVCVincent ChanYXYan Xu

Discussion

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Overview

May support caution omitting postoperative bridging; leaves open need for randomized trials to guide mechanical valve management.

Study Design

Type

Cohort (n=373)

Multicenter

No

Structured PICO

Does the omission of postoperative therapeutic-dose bridging increase the risk of arterial thromboembolism or bleeding in patients with mechanical heart valves undergoing VKA interruption?

P
Population
373 adult patients with left-sided mechanical heart valves undergoing planned invasive procedures requiring temporary interruption of vitamin K antagonist therapy, followed for 30 days.
E
Exposure
Temporary interruption of vitamin K antagonist (VKA) therapy with therapeutic-dose bridging (used preoperatively in 84.2% and postoperatively in 31.5% of interruptions).
C
Comparator
Omission of postoperative therapeutic-dose bridging.
O
Outcome
30-day postoperative arterial thromboembolism (ATE) and major bleeding.hard clinical

Main Result

Hazard Ratio: 5.3 (95% CI 1.45–19.4)

Absolute Event Rate: 4.9% vs 0.9%

p-value: p=.01

In patients with mechanical heart valves undergoing invasive procedures, omitting postoperative bridging during VKA interruption may be associated with an increased risk of arterial thromboembolism.

Limitations

  • Does not establish a causal protective effect of postoperative bridging
  • Exploratory analyses pending stronger evidence from representative cohorts
  • Does not establish a causal protective effect
  • Exploratory analyses
  • Requires stronger evidence from representative cohorts

Cite This Study

Hrubesz et al. (2026) conducted a cohort in Mechanical heart valves requiring VKA interruption (n=373). Omission of postoperative bridging vs. Postoperative bridging was evaluated on 30-day postoperative arterial thromboembolism (ATE) (sHR 5.30, 95% CI 1.45-19.40, p=.01). Omission of postoperative bridging in patients with mechanical heart valves was associated with a higher 30-day risk of arterial thromboembolism (4.9% vs 0.9%; sHR 5.30; 95% CI 1.45-19.40; P=.01).

synapsesocial.com/papers/6a9c5b3de186ce8f4790b751https://doi.org/10.1001/jamanetworkopen.2026.32282
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