Bridging with the Low molecular weight heparin certoparin in patients requiring temporary discontinuation of oral anticoagulation ― the non-interventional, retrospective REMEMBER study

Background: Bridging of a temporal discontinuation of oral anticoagulation with low molecular weight heparins (LMWH) is common practice. Specific data on the LMWH certoparin are however limited despite its wide spread use. We aimed to assess effectiveness and safety of certoparin in this indication under real world conditions. Methods: Retrospective, non-controlled, non-interventional study at hospital- and office based physicians in Germany documenting 259 patients undergoing surgery (trauma, orthopaedic or general), endoscopy or a coronary intervention and who were receiving certoparin to bridge the temporal discontinuation of oral anticoagulation. Results: Patients had a mean age of 70.4 ± 11.5 years, a body weight of 81.9 ± 16.2 kg and 40.9% were female. Most received oral anticoagulation because of atrial fibrillation (57.5%) and most underwent surgery (55.6%). Oral anticoagulant treatment was discontinued a mean of 6.4 ±2.3 days prior to the intervention and resumed 3.6 ± 3.8 days after the intervention. Certoparin, used in 74.9% of patients at a full therapeutic dose of 1x8,000 IE, was started about 3 days after VKA discontinuation when the mean INR was 1.7 ± 0.4 and patients received the last dose of certoparin a mean of 16.2 ± 7.1 h before the intervention. It was resumed 12.2 ± 7.7 h after the intervention and stopped at day 7 when the INR had reached 2.2 ± 0.4. No case of clinically overt deep vein thrombosis and no case of pulmonary embolism was reported. Seven patients (2.7%) had any minor and 4 (1.5%) any major bleeding complication. Conclusions: The analysis suggests that certoparin is safe and effective to bridge the temporal discontinuation of oral anticoagulation during surgery, endoscopy or a coronary intervention. It further confirms that current use patterns are appropriate in daily practice in Germany to ensure patient safety.