Periprocedural Bridging Anticoagulation in Patients with Venous Thromboembolism: A Registry-based Cohort Study

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Journal of thrombosis and haemostasis


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) have 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 (ACCP) 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, IQR 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 to low- or moderate-risk patients in both unadjusted (p=0.013) and patient-level cluster-adjusted analyses (p=0.031). Adherence to ACCP guidelines in high- and low-risk patients did not change during the study period (OR 0.98 per year, 95% CI 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.

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ePub ahead of print