Prospective Double-Arm Study of Fibrinolysis in Surgical Patients

Kosir, Mary A.; Schmittinger, Lisa; Barno-Winarski, Lisa; Duddella, Padimaja; Pone, Mark; Perales, Anthony; Lange, P; Brish, Linda K.; McGee, Karen; Beleski, Karen; Pawlak, Julie; Mammen, Eberhard F.; Sajahan, Nisha P.; Kozol, Robert A.

doi:10.1006/jsre.1997.5233

Cited by 34 publications

(22 citation statements)

References 14 publications

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“…34 The premise that warfarin interruption leads to rebound hypercoagulability and that the milieu of the procedure confers a prothrombotic state, which in turn leads to arterial thromboembolism, is not supported by the results of this trial. 35–37 …”

Section: Discussionmentioning

confidence: 99%

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

et al. 2015

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BACKGROUND It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. RESULTS In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], −0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). CONCLUSIONS In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474.)

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Section: Discussionmentioning

confidence: 99%

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

et al. 2015

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“…This incidence could be compared with the 6.3% rate of DVT in patients with cancer receiving no prophylaxis and 1.8% in those receiving heparin, as detected by ultrasound evaluation. 27,28 The rate of symptomatic DVT in patients receiving heparin after major surgeries is, however, much lower, usually in the range of 0.5% to 2%. 29 Thus, we can estimate that the risk of DVT after major surgery in patients with PV and ET is at least 5-fold increased, confirming the predisposition to thrombosis in patients with cMPD.…”

Section: Discussionmentioning

confidence: 99%

Postsurgery outcomes in patients with polycythemia vera and essential thrombocythemia: a retrospective survey

Ruggeri

Rodeghiero

Tosetto

et al. 2008

Blood

110

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“…[75][76][77] Similarly, the surgical milieu has been found to induce a hypercoagulable state, including increased levels of plasminogen acti-vator inhibitor-1. [78][79][80] Although clinical studies examining perioperative bridging therapy have not had sufficient power to make precise determinations of the perioperative stroke rate, most trials have found rates greater than would be expected mathematically. 3,81,82 The base-case analysis indicates that a transient hypercoagulable state that increased the arterial thromboembolic rate more than 1.4 times the baseline rate would result in the aggressive strategy being preferred over the minimalist strategy.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management of Patients on Oral Anticoagulants: A Decision Analysis

Dunn

Wisnivesky

et al. 2005

Med Decis Making

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For most patients with a mechanical aortic valve or atrial fibrillation undergoing major surgery, a minimalist strategy of simply withholding oral anticoagulation provides similar QALE as an aggressive strategy of administering perioperative subcutaneous LMWH or intravenous heparin. The aggressive therapy provides greater QALE for patients at higher risk of stroke (e.g., mechanical mitral valves), although the benefit is small.

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Prospective Double-Arm Study of Fibrinolysis in Surgical Patients

Cited by 34 publications

References 14 publications

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

Postsurgery outcomes in patients with polycythemia vera and essential thrombocythemia: a retrospective survey

Perioperative Management of Patients on Oral Anticoagulants: A Decision Analysis

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