ORIGINAL ARTICLE
Periprocedural bridging anticoagulation in patients with venous thromboembolism: A registry‐based cohort study

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Abstract

Background

Use of bridging anticoagulation increases a patient's bleeding risk without clear evidence of thrombotic prevention among warfarin‐treated patients with atrial fibrillation. Contemporary use of bridging anticoagulation among warfarin‐treated patients with venous thromboembolism (VTE) has not been studied.

Methods

We identified warfarin‐treated patients with VTE who temporarily stopped warfarin for a surgical procedure between 2010 and 2018 at six health systems. Using the 2012 American College of Chest Physicians guideline, we assessed use of periprocedural bridging anticoagulation based on recurrent VTE risk. Recurrent VTE risk and 30‐day outcomes (bleeding, thromboembolism, emergency department visit) were each assessed using logistic regression adjusted for multiple procedures per patient.

Results

During the study period, 789 warfarin‐treated patients with VTE underwent 1529 procedures (median, 2; interquartile range, 1‐4). Unadjusted use of bridging anticoagulation was more common in patients at high risk for VTE recurrence (99/171, 57.9%) than for patients at moderate (515/1078, 47.8%) or low risk of recurrence (134/280, 47.86%). Bridging anticoagulation use was higher in high‐risk patients compared with low‐ or moderate‐risk patients in both unadjusted (P = .013) and patient‐level cluster‐adjusted analyses (P = .031). Adherence to American College of Chest Physicians guidelines in high‐ and low‐risk patients did not change during the study period (odds ratio, 0.98 per year; 95% confidence interval, 0.91‐1.05). Adverse events were rare and not statistically different between the two treatment groups.

Conclusions

Bridging anticoagulation was commonly overused among low‐risk patients and underused among high‐risk patients treated with warfarin for VTE. Adverse events were rare and not different between the two treatment groups.

Keywords

anticoagulation
heparin
low‐molecular‐weight
perioperative
venous thromboembolism
warfarin

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Manuscript handled by: Jean Connors

Final decision: Jean Connors, 08 May 2020

Funding informationBlue Cross Blue Shield of Michigan and National Institutes of Health/National Heart, Lung, and Blood Institute (K01HL135392 to G.D.B.). The funding organizations had no role in the design and conduct of the study; data collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.