Anticoagulant Use, the Prevalence of Bridging, and Relation to Length of Stay among Hospitalized Patients with Non-Valvular Atrial Fibrillation

Smoyer‐Tomic, Karen E.; Siu, Kimberly; Walker, David; Johnson, Barbara H.; Smith, David M.; Sander, Stephen; Amin, Alpesh

doi:10.1007/bf03262474

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…21 However, two other studies showed that the extent of use of anticoagulant was 76-79%. 29,30 Anti platelets prescribed in 30.63% patients in our study was similar to study in United States where 45.9% patients were prescribed antiplatelets. 31 However, one study in China showed that 73.4% patients were prescribed antiplatelets.…”

Section: Discussionsupporting

confidence: 84%

Utilization Pattern of Antiplatelet and Anticoagulant Medicines Among the Patients Suffering From Atrial Fibrillation

Jadav¹,

Dumatar²

2016

IJMEDPH

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Background: Antithrombotic therapy is recommended in atrial fibrillation (AF) patients due to high risk of stroke. However, antithrombotic therapy is often underutilized due to adverse effects and limited data available in Indian population. Aims: Primary objective was to study usage pattern of antiplatelet and anticoagulant drugs in AF patients. Secondary objective was to assess the risk of stroke and compare usage pattern of antithrombotic drugs in non-valvular atrial fibrillation (NVAF) patients with application of CHADS2 and CHA2DS2-VASc score. Materials and Methods: A prospective and observational study was conducted in outpatient department for period of one year in patients > 35 years of either gender diagnosed with AF due to any established cause. CHADS2 and CHA2DS2-VASc score were used to assess risk of stroke among NVAF patients. Results: 111 patients diagnosed with AF (mean age 54 years; 54.96% female) were analyzed and out of these, 78 patients were valvular AF patients and 33 were NVAF patients. Anticoagulants were predominantly prescribed in 60 valvular AF patients. Out of 33 NVAF patients, 19 (57.57%) patients had CHADS2 score 1 while as per CHA2DS2-VASc score 28 (84.84%) patients had score ≥ 2. Out of 33 NVAF patients, 15 (45.45%) patients were prescribed warfarin, aspirin in 12 (36.36%) patients and no antithrombotic therapy in 6 (18.18%) patients. Conclusion: Oral anticoagulant drugs are most commonly prescribed antithrombotic drugs in valvular AF and NVAF patients for stroke prevention. CHADS2 and CHA2DS2-VASc score are easy, simple schemes to assess stroke risk in NVAF patients and helps physicians and patients to choose most suitable antithrombotic therapy.

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Section: Discussionsupporting

confidence: 84%

Utilization Pattern of Antiplatelet and Anticoagulant Medicines Among the Patients Suffering From Atrial Fibrillation

Jadav¹,

Dumatar²

2016

IJMEDPH

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“…This study suggests that heparin bridging may not be needed during the initiation of OAC in NVAF patients. The frequency of heparin bridging is reported to range from 5% to 64% in several retrospective studies [12][13][14][15], and it is 19.6% in this study. However, the actual incidence of heparin-bridging therapy in warfarin-na€ ıve patients remains unknown.…”

Section: Heparin-bridging Therapy At Oac Initiationmentioning

confidence: 46%

“…However, the actual incidence of heparin-bridging therapy in warfarin-na€ ıve patients remains unknown. A recent study by Smoyer-Tomic et al reported that 64% of 3037 hospitalized patients with NVAF received bridging therapy [14,15], and most patients had no evidence of warfarin use in the 6-month period before hospitalization. Therefore, newly diagnosed NVAF patients seem to have received OAC with a considerable proportion of concurrent heparin-bridging therapy in real-world practice, especially if they were hospitalized.…”

Section: Heparin-bridging Therapy At Oac Initiationmentioning

confidence: 99%

“…Therefore, heparin is often used as a "bridge" when initiating warfarin therapy in patients with AF, not only because physicians feel a need to begin anticoagulation as soon as possible for stroke prevention but also because they want to protect patients from this presumed transient hypercoagulable state. The frequency of heparin bridging in OAC initiation is variously reported to range from 5% to 64% in several retrospective studies [12][13][14][15]. Because 25-50% of patients with AF are asked to interrupt OAC before an invasive procedure or surgery every year, many studies have been published concerning the risk and benefit of bridging anticoagulation, and current international guidelines recommend the use of bridging therapy in AF patients undergoing interruptions of warfarin who are considered to be at high thromboembolic (TE) risk, such as patients with prosthetic heart valves, venous thromboembolism, valvular AF, or AF with higher CHADS 2 scores (estimates risk based on the presence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and prior stroke or transient ischemic attack) [8,[16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non‐valvular atrial fibrillation patients: a multicenter propensity‐matched analysis

Kim

Mun

et al. 2015

Journal of Thrombosis and Haemostasis

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To cite this article: Kim TH, Kim JY, Mun HS, Lee HY, Roh YH, Uhm JS, Pak HN, Lee MH, Joung B. Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients: a multicenter propensity-matched analysis. J Thromb Haemost 2015; 13: 182-90.Summary. Background: The efficacy of heparin-bridging therapy during the initiation of oral anticoagulation therapy (OAC) in non-valvular atrial fibrillation (NVAF) is unclear. Objectives: To evaluate the efficacy and the safety of heparin-bridging therapy during OAC initiation in NVAF patients. Patients/Methods: This study included 5327 consecutive warfarin-na€ ıve NVAF patients who received OAC that was initiated with (n = 1053) or without (n = 4274) heparin bridging at four tertiary hospitals. Stroke and bleeding events within 30 days of OAC were evaluated. Results: While there was no difference in the incidence of stroke (0.5% vs. 0.3%, P = 0.381), major bleeding rate (0.9% vs. 0.3%, P = 0.004) was higher in heparin-bridged than in non-bridged patients. This trend remained in the propensity score-matched population (stroke 0.5% vs. 0.6%, P = 0.762; major bleeding 0.8% vs. 0.1%, P = 0.019). A high CHA 2 DS 2 -VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS 2 or CHA 2 DS 2 -VASc scores. The HAS-BLED score had a predictive value for major bleeding (odds ratio 1.80, 95% confidence interval 1.11-2.92, P = 0.018), and heparin-bridging therapy was associated with a higher major bleeding rate (odds ratio 4.44, 95% confidence interval 1.68-11.72, P = 0.003), especially in patients with a HAS-BLED score of ≥ 1. Conclusions:The heparin-bridging therapy increased bleeding without the benefit of preventing stroke at the initiation of OAC in NVAF. Our data suggest that heparin bridging should not be considered at the initiation of OAC in NVAF patients.

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“…Adoption of a low intensity UFH regimen in hospitalized AF patients requiring bridging would reduce any bleeding in approximately 6400 patients and major bleeding in approximately 4200 patients per year in the United States. This is based on an extrapolation from 326 000 000 million Americans, 2115 AF hospitalizations per 1 million US population per year (assuming a 14.4% relative increase from 2010 statistics), 48% of AF patients being anticoagulated with 64% of those being bridged and 54% of them using UFH, equating to 114 411 AF patients being bridged with UFH per year. Applying the results of this study, a 5.6% absolute reduction in any bleed and 3.7% absolute reduction in major bleeds, would estimate the bleed events averted as noted above.…”

Section: Discussionmentioning

confidence: 99%

The effect of heparin infusion intensity on outcomes for bridging hospitalized patients with atrial fibrillation

Warden

Diep

Ran

et al. 2019

Clinical Cardiology

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Background Perioperative bridging in atrial fibrillation (AF) is associated with low thromboembolic rates but high bleeding rates. Recent guidance cautions the practice of bridging except in high risk patients. However, the practice of bridging varies widely and little data exist regarding appropriate anticoagulation intensity when using intravenous unfractionated heparin (UFH). Hypothesis To determine if high intensity UFH infusion regimens are associated with increased bleeding rates compared to low intensity regimens for bridging patients with AF. Methods We conducted a single center retrospective cohort study of admitted patients with non‐valvular AF receiving UFH for ≥24 hours. UFH intensities were chosen at the providers' discretion. The primary endpoint was the rate of bleeding defined by the International Society on Thrombosis and Hemostasis during UFH infusion or within 24 hours of discontinuation. The secondary endpoint was a composite of cardiovascular events, arterial thromboembolism, venous thromboembolism, myocardial infarctions and death during UFH infusion. Results A total of 497 patients were included in this analysis. Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of patients. The rate of any bleed was higher among high intensity compared to low intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval = 1.07‐4.90). Major bleeding was significantly higher among high intensity compared to low intensity UFH regimens. There was no difference in composite thrombotic events or death. Conclusions Low intensity UFH infusions, targeting lower anticoagulation targets, were associated with decreased bleeding rates without a signal of increased thromboembolic events in hospitalized AF patients.

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Anticoagulant Use, the Prevalence of Bridging, and Relation to Length of Stay among Hospitalized Patients with Non-Valvular Atrial Fibrillation

Cited by 13 publications

References 25 publications

Utilization Pattern of Antiplatelet and Anticoagulant Medicines Among the Patients Suffering From Atrial Fibrillation

Utilization Pattern of Antiplatelet and Anticoagulant Medicines Among the Patients Suffering From Atrial Fibrillation

Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non‐valvular atrial fibrillation patients: a multicenter propensity‐matched analysis

The effect of heparin infusion intensity on outcomes for bridging hospitalized patients with atrial fibrillation

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