The IV heparin recommended by Peter F. Cohn, MD, as bridging therapy when warfarin has to be stopped in a pa-tient with an artificial heart valve (Item 99-12) requires a long hospital stay. Why not use outpatient enoxaparin, withholding a dose 12 hours before the procedure and continuning postoperatvely until the international normalized ratio is therapeutic?
—Ronald L. Hirsch, MD, Elgin, Ill. (100-25)