Abstract
Background
Before surgery, most patients receiving oral anticoagulation require temporary cessation
of treatment. Physicians sometimes substitute heparin or low-molecular-weight heparin
for oral anticoagulation in the perioperative setting (“bridging therapy”). We sought
to characterize rates of bridging therapy use at 9 clinical centers to determine the
extent to which the use of bridging is explained by clinical characteristics of patients
(vs physician style) and to determine the 30-day incidence of thrombotic and bleeding
complications.
Methods
This was a prospective, multicenter, observational study. Periprocedural bridging
anticoagulation was classified as none, prophylactic-dose heparin/low-molecular-weight
heparin, or full-dose heparin/low-molecular-weight heparin. We collected data on patient
and surgery characteristics, anticoagulation management, and thromboembolic and bleeding
events.
Results
A total of 492 of 497 consecutive patients completed the study; 54%, 14%, and 33%
of patients had no, prophylactic, and full (therapeutic) doses, respectively, of heparin/low-molecular-weight
heparin postprocedure. Two hospitals treated more than 80% of their patients with
full-dose heparin, whereas the remaining 7 hospitals used full-dose heparin in an
average of 22% of cases (P<.001); this variation persisted after adjustment for patient characteristics. There
were 4 thromboembolic events (0.8%) and 16 major bleeding events (3.2%). Full-dose
heparin/low-molecular-weight heparin postprocedure was associated with a higher likelihood
of major bleeding: adjusted odds ratio 4.4 (95% confidence interval, 1.5-14.7).
Conclusion
Management of anticoagulation after an invasive procedure varies widely and is not
explained by clinical characteristics of patients alone. The risk of major bleeding
is strongly associated with the use of postoperative therapeutic doses of heparin/low-molecular-weight
heparin.
Keywords
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Article info
Footnotes
Funding: This study was funded by an investigator sponsored grant from Astra-Zeneca International. Additional funding was provided by the Johns Hopkins Hospitalist Scholars Program.
Conflict of Interest: Dr Jaffer has received a research grant from Astra Zeneca and served as a consultant to Astra Zeneca. Dr White has received funding from Astra-Zeneca International for other investigator-initiated studies. All other authors have no conflicts of interest to declare.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
