May 10, 2006Current Medical Research and Opinion
Periprocedural bridging therapy in patients receiving chronic oral anticoagulation therapy
Why the study?
Is low-molecular-weight heparin as effective and safe as unfractionated heparin for periprocedural bridging therapy in patients on chronic oral anticoagulation?
Population
Patients receiving chronic oral anticoagulation with vitamin K antagonists requiring temporary…
Comparison
Periprocedural bridging therapy with… vs Unfractionated heparin compared with…
Design
Systematic_review
Authors
Discussion
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Implication
Supports outpatient LMWH bridging with cost savings in eligible patients; extends evidence base for upgrading ACCP recommendations from 2C to 1C.
Key Points
- To review the safety, efficacy, and clinical recommendations for periprocedural heparin bridging therapy during temporary discontinuation of chronic vitamin K antagonist treatment.
- Conducted a systematic narrative review of clinical studies evaluating heparin bridging strategies in patients receiving chronic oral anticoagulation who required invasive procedures.
- Low-molecular-weight heparin (LMWH) demonstrated low thromboembolism rates with safety and efficacy qualitative profiles comparable to unfractionated heparin (UFH).
- Outpatient LMWH bridging provided predictable anticoagulant effects and significant cost savings relative to in-hospital UFH administration.
- Therapeutic-dose UFH or LMWH bridging is supported for patients at intermediate-to-high thromboembolic risk undergoing low bleeding risk procedures, prompting a proposed guideline upgrade from 2C to 1C.
Structured PICO
Is low-molecular-weight heparin as effective and safe as unfractionated heparin for periprocedural bridging therapy in patients on chronic oral anticoagulation?
P
Population
Patients receiving chronic oral anticoagulation with vitamin K antagonists (VKAs) requiring temporary discontinuation for surgery or other invasive procedures, specifically those at intermediate-to-high risk of thromboembolism (e.g., prosthetic heart valves or atrial fibrillation).
I
Intervention
Periprocedural bridging therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH).
C
Comparator
Unfractionated heparin (UFH) compared with low-molecular-weight heparin (LMWH).
O
Outcome
Rates of thromboembolism and bleeding.hard clinical
LMWH is an effective, safe, and cost-saving alternative to UFH for periprocedural bridging in patients at intermediate-to-high thromboembolic risk, prompting authors to propose upgrading ACCP guideline recommendations.
Limitations
- Lack of randomized controlled trials on the efficacy and safety of available bridging strategies, including heparin and placebo comparators
Cite This Study
Spyropoulos et al. (2006) studied this question.