Decline in Periprocedural Anticoagulant Use in Warfarin-Treated VTE Patients Following the Bridge Trial Publication
Barnes G, Li Y, Gu X, Haymart B, Kline-Rogers E, Ali M, Kozlowski J, Krol G, Froehlich J, and Kaatz S. Decline in Periprocedural Anticoagulant Use in Warfarin-Treated VTE Patients Following the Bridge Trial Publication. Res Pract Thromb Haemost 2019; 3:845-846.
Res Pract Thromb Haemost
Background : It is unclear how large randomized trials in one patient population (e.g. BRIDGE trial in atrial fibrillation) impact care in different populations (e.g. venous thromboembolism [VTE]). Aims : To evaluate the impact of the BRIDGE trial on the use of periprocedural bridging low- molecular- weight heparin (LMWH) among warfarin- treated patients with VTE. Methods : Patients initiated on warfarin at six health centers in the Michigan Anticoagulation Quality Improvement Initiative (MAQI 2 ) beginning in 2010 were followed through April 2018. We performed a quasi- experimental interrupted time series analysis (ITSA) to evaluate the impact of the BRIDGE trial publication (July 2015) by examining any chance in bridging LMWH use after the trial publication. The ISTA uses a logistic regression model on bi- monthly use of LMWH bridging with a time- dependent indicator for the timing of the BRIDGE trial. Results : Between July 2010 and April 2018, 744 warfarin- treated patients with VTE experienced 1463 temporary interruptions for surgical procedures (median 2/patient, IQR 1- 4; Table). If the BRIDGE trial has not been published, the use of bridging anticoagulation would have continued to increase to 68.8% (95% CI 58.3%- 79.4%) post- BRIDGE trial. However, with the BRIDGE trial publication, the use of bridging LMWH decreased to 48.7% (95% CI 40.9%- 56.4%) post- BRIDGE trial. Hence, the BRIDGE trial was associated with a decrease in LMWH bridging of 20.1% (95% CI 7.1%- 33.3%, p=0.003) (Figure). There was no difference in 30- day major or non- major bleeding. We observed a trend for fewer emergency department visits in the pre- and post- BRIDGE periods (Table). Conclusions : Use of bridging LMWH in warfarin- treated patients with VTE has declined since July 2015, the same time that the BRIDGE trial of patients with atrial fibrillation was published. (Figure Presented).