Key result
Bridge therapy during warfarin interruption shows no significant difference in 30-day bleeding for mechanical valves.
Why the study?
The benefits of bridge therapy in patients with mechanical heart valve prostheses interrupting warfarin for invasive procedures are not well described.
Does bridge therapy increase bleeding or prevent thromboembolism in patients with mechanical heart valves interrupting warfarin for invasive procedures?
Cohort (n=355)
Does bridge therapy increase bleeding or prevent thromboembolism in patients with mechanical heart valves interrupting warfarin for invasive procedures?
In patients with mechanical heart valves interrupting warfarin for procedures, bridge therapy is frequently used and may be associated with a numerically higher risk of bleeding without any observed thromboembolic events in either group.
Answers are grounded in this paper and cite their sources.
May increase bleeding without thromboembolic benefit; leaves open need for RCTs to guide bridging in mechanical valves.
BACKGROUND: Bridge therapy is associated with an increased risk of major bleeding in patients with atrial fibrillation and venous thromboembolism (TE) without a corresponding reduction in TE. The benefits of bridge therapy in patients with mechanical heart valve (MHV) prostheses interrupting warfarin for invasive procedures are not well described. METHODS AND RESULTS: A retrospective cohort study was conducted at an integrated health-care delivery system. Anticoagulated patients with MHV interrupting warfarin for invasive diagnostic or surgical procedures between January 1, 2006, and March 31, 2012, were identified. Patients were categorized according to exposure to bridge therapy during the periprocedural period and TE risk (low, medium, and high). Outcomes validated via manual chart review included clinically relevant bleeding, TE, and all-cause mortality in the 30 days following the procedure. There were 547 procedures in 355 patients meeting inclusion criteria. Mean cohort age was 65.2 years, and 38% were female. Bridge therapy was utilized in 466 (85.2%) procedures (95.2%, 77.3%, and 65.8% of high, medium, and low TE risk category procedures, respectively). The 30-day rate of clinically relevant bleeding was numerically higher in bridged (5.8%; 95% confidence interval [CI], 3.9%-8.3%) versus not bridged procedures (1.2%; 95% CI, <0.1%-6.7%; P = .102). No TEs or deaths were identified. CONCLUSION: The use of bridge therapy is common among patients with MHV and may be associated with increased bleeding risk. Further research is needed to determine whether bridge therapy reduces TE in patients with MHV interrupting warfarin for invasive procedures.
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Delate et al. (2016) conducted a cohort in Mechanical heart valve prostheses interrupting warfarin for invasive procedures (n=355). Bridge therapy vs. No bridge therapy was evaluated on Clinically relevant bleeding at 30 days (p=0.102). Bridge therapy during warfarin interruption in patients with mechanical heart valves was associated with a numerically higher 30-day rate of clinically relevant bleeding (5.8% vs 1.2%; P=0.102).
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