Anticoagulation Bridging Unnecessary in Surgical AF Patients
By HospiMedica International staff writers Posted on 29 Jun 2015 |
Patients with atrial fibrillation (AF) who stopped warfarin before they had elective surgery faced no higher risks than those who were given a “bridge” therapy, according to a new study.
Researchers at Duke University Medical Center (Duke; Durham, NC, USA) conducted a randomized trial in which 1,884 patients who interrupted warfarin therapy before surgery were randomly assigned to receive bridging anticoagulation with low-molecular-weight heparin, or matching placebo. Follow-up of the patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (TE), as manifested by stroke, systemic embolism, or transient ischemic attack (TIA), and major bleeding.
In total, 950 patients were assigned to receive no bridging therapy, while 934 were assigned to receive bridging therapy. The incidence of arterial TE was 0.4% in the no-bridging group, and 0.3% in the bridging group, while the incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group. The researchers stressed that the findings are specific to patients with AF who take warfarin, and should not be generalized. The study was published on June 22, 2015, in the New England Journal of Medicine (NEJM).
“Bridging does not improve the outcome for stroke prevention, but increases the risk of major bleeding complications. That's the counter balance - we're not doing patients any good, and we are potentially hurting them,” said senior author Thomas Ortel, MD, PhD, chief of the division of hematology at Duke. “This is the first study to provide high-quality clinical trial data demonstrating that for patients with atrial fibrillation who need a procedure and who need to come off warfarin, they can simply stop and restart; they do not need to be bridged.”
Current practice calls for AF patients to halt warfarin therapy for five days before and after they undergo an elective procedure, because it can cause dangerous bleeding and slow healing. After the procedure and resuming warfarin, it may take five or more days before the anticoagulant reaches its effective target therapeutic level. To continue protecting the surgical patients from TE during this intermission period, many doctors prescribe low-molecular weight heparin as a "bridging" therapy.
Related Links:
Duke University Medical Center
Researchers at Duke University Medical Center (Duke; Durham, NC, USA) conducted a randomized trial in which 1,884 patients who interrupted warfarin therapy before surgery were randomly assigned to receive bridging anticoagulation with low-molecular-weight heparin, or matching placebo. Follow-up of the patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (TE), as manifested by stroke, systemic embolism, or transient ischemic attack (TIA), and major bleeding.
In total, 950 patients were assigned to receive no bridging therapy, while 934 were assigned to receive bridging therapy. The incidence of arterial TE was 0.4% in the no-bridging group, and 0.3% in the bridging group, while the incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group. The researchers stressed that the findings are specific to patients with AF who take warfarin, and should not be generalized. The study was published on June 22, 2015, in the New England Journal of Medicine (NEJM).
“Bridging does not improve the outcome for stroke prevention, but increases the risk of major bleeding complications. That's the counter balance - we're not doing patients any good, and we are potentially hurting them,” said senior author Thomas Ortel, MD, PhD, chief of the division of hematology at Duke. “This is the first study to provide high-quality clinical trial data demonstrating that for patients with atrial fibrillation who need a procedure and who need to come off warfarin, they can simply stop and restart; they do not need to be bridged.”
Current practice calls for AF patients to halt warfarin therapy for five days before and after they undergo an elective procedure, because it can cause dangerous bleeding and slow healing. After the procedure and resuming warfarin, it may take five or more days before the anticoagulant reaches its effective target therapeutic level. To continue protecting the surgical patients from TE during this intermission period, many doctors prescribe low-molecular weight heparin as a "bridging" therapy.
Related Links:
Duke University Medical Center
Latest Surgical Techniques News
- Miniaturized Implantable Multi-Sensors Device to Monitor Vessels Health
- Tiny Robots Made Out Of Carbon Could Conduct Colonoscopy, Pelvic Exam or Blood Test
- Miniaturized Ultrasonic Scalpel Enables Faster and Safer Robotic-Assisted Surgery
- AI Assisted Reading Tool for Small Bowel Video Capsule Endoscopy Detects More Lesions
- First-Ever Contact Force Pulsed Field Ablation System to Transform Treatment of Ventricular Arrhythmias
- Caterpillar Robot with Built-In Steering System Crawls Easily Through Loops and Bends
- Tiny Wraparound Electronic Implants to Revolutionize Treatment of Spinal Cord Injuries
- Small, Implantable Cardiac Pump to Help Children Awaiting Heart Transplant
- Gastrointestinal Imaging Capsule a Game-Changer in Esophagus Surveillance and Treatment
- World’s Smallest Laser Probe for Brain Procedures Facilitates Ablation of Full Range of Targets
- Artificial Intelligence Broadens Diagnostic Abilities of Conventional Coronary Angiography
- AI-Powered Surgical Visualization Tool Supports Surgeons' Visual Recognition in Real Time
- Cutting-Edge Robotic Bronchial Endoscopic System Provides Prompt Intervention during Emergencies
- Handheld Device for Fluorescence-Guided Surgery a Game Changer for Removal of High-Grade Glioma Brain Tumors
- Porous Gel Sponge Facilitates Rapid Hemostasis and Wound Healing
- Novel Rigid Endoscope System Enables Deep Tissue Imaging During Surgery