Key result
Heparin bridging increases major bleeding to ~3.2% without preventing arterial thromboembolism during warfarin interruption.
Why the study?
Does heparin bridging therapy prevent arterial thromboembolism without increasing major bleeding in adults with atrial fibrillation undergoing temporary interruption of warfarin therapy for elective procedures?
Does heparin bridging therapy prevent arterial thromboembolism without increasing major bleeding in adults with atrial fibrillation undergoing temporary interruption of warfarin therapy for elective procedures?
This review highlights that forgoing heparin bridging during perioperative warfarin interruption is safe, non-inferior for preventing thromboembolism, and reduces major bleeding risk in patients with atrial fibrillation.
May support avoiding routine heparin bridging in AF patients for elective procedures to reduce bleeding; confirms BRIDGE trial in literature synthesis.
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Shannon Paquette (2018) conducted a review in Atrial fibrillation or flutter requiring temporary interruption of warfarin therapy for an elective procedure or surgery (n=1,884). Heparin bridging (dalteparin) vs. Placebo (non-bridging) was evaluated on Major bleeding (RR 0.41 (placebo compared to heparin-bridged), p=0.005 for superiority). Heparin bridging therapy resulted in a higher incidence of major bleeding compared to placebo (3.2% vs 1.3%, P=0.005) while offering no significant advantage in preventing arterial thromboembolism during temporary warfarin interruption in patients with atrial fibrillation.
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