August 8, 2005Current Opinion in Internal Medicine
Perioperative bridging interruption with heparin for the patient receiving long-term anticoagulation
Why the study?
Is perioperative bridging therapy with heparin safe and effective for patients on long-term oral anticoagulation undergoing elective procedures?
Population
At-risk patients receiving long-term oral anticoagulation requiring temporary interruption for an elective…
Design
Review
Authors
Discussion
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Member takes
Implication
May inform bridging decisions amid bleeding concerns; leaves open net benefit pending randomized perioperative trials.
Key Points
- To review recent clinical data on the safety, efficacy, and management of heparin bridging therapy in patients receiving long-term oral anticoagulation who require temporary interruption for elective invasive procedures or surgery.
- Reviewed published clinical data, including a systematic review of pre-2001 studies and subsequent large prospective cohort studies and patient registries.
- Evaluated perioperative outcomes associated primarily with treatment-dose low-molecular-weight heparin and unfractionated heparin in patients undergoing elective major and non-major procedures, including those with mechanical heart valves.
- Demonstrated an overall thromboembolic complication rate of 1.22 (95% CI, 0.81–1.77) among patients undergoing perioperative heparin bridging therapy.
- Identified an overall major bleeding rate of 2.94 (95% CI, 2.28–3.74) across prospective cohort and registry evaluations.
- Standardized low-molecular-weight heparin regimens guided by postoperative bleeding risk assessments achieved favorable clinical outcomes and reduced hospital length of stay compared to unfractionated heparin.
Structured PICO
Is perioperative bridging therapy with heparin safe and effective for patients on long-term oral anticoagulation undergoing elective procedures?
P
Population
At-risk patients receiving long-term oral anticoagulation (including those with mechanical heart valves) requiring temporary interruption for an elective invasive procedure or surgery
I
Intervention
Perioperative bridging therapy with heparin (unfractionated heparin or low-molecular-weight heparin)
O
Outcome
Thromboembolic complications and major bleedingsafety
Perioperative bridging therapy with heparin appears safe and effective for patients on long-term oral anticoagulation requiring temporary interruption, though randomized trials are needed.
Limitations
- Quality of studies published before June 2001 was generally poor
- Lack of randomized double-blind placebo-controlled trials
Cite This Study
Spyropoulos et al. (2005) studied this question.