TY - JOUR
T1 - Low molecular weight heparin bridging for atrial fibrillation
T2 - Is VTE thromboprophylaxis the major benefit?
AU - Billett, Henny H.
AU - Scorziello, Barbara A.
AU - Giannattasio, Emily R.
AU - Cohen, Hillel W.
N1 - Funding Information:
Acknowledgments This publication was made possible by the CTSA Grant UL1 RR025750, KL2 RR025749 and TL1 RR025748 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessary represent the official view of the NCRR or NIH. We also gratefully acknowledge Eran Bellin MD, PhD for the development and availability of Clinical Looking Glass.
PY - 2010/11
Y1 - 2010/11
N2 - Paucity of data has led to a lack of consensus regarding indications for, and risk-benefit ratio of, low molecular weight heparin 'bridging' for cardioembolic prevention in patients with atrial fibrillation (AF) until their INR levels are in therapeutic range. Using a hospital database, we compared AF patients C65 years who were bridged (n = 265) with patients who were not bridged (n = 4532) after hospital discharge. Patients who failed to achieve a therapeutic INR within 30 days were excluded. CHADS2 scores (congestive heart failure, hypertension, age C75, diabetes, stroke), bleeding risk and co-morbidity scores were assessed. Unadjusted and adjusted odds ratios for outcome events (death, stroke, hemorrhage and venous thromboembolism (VTE) within 30 days of discharge were compared. Bridged patients, as compared to those not bridged, were younger (74.7 ± 6.6 vs. 78.5 ± 7.7 years), less likely to be white (36 vs. 51%), and less likely to have CHADS2 scores ≥2 (67 vs. 84%), all P<0.001. There was no significant difference in bleeding risk (bridged vs. not bridged: 1.5 ± 7 vs. 1.7 ± 6). In logistic models adjusting for age, white race, bleeding risk, CHADS 2 and Comorbidity scores, bridging was significantly associated with lower mortality and a decreased odds ratio for VTE (both P<0.01) but not for stroke or hemorrhage (both P>0.80). Although we found insufficient evidence of either lower stroke or greater bleeding risk with bridging, our data suggest the possibility that LMWH bridging in patients with AF is associated with lower risks of VTE and death within 30 days of discharge.
AB - Paucity of data has led to a lack of consensus regarding indications for, and risk-benefit ratio of, low molecular weight heparin 'bridging' for cardioembolic prevention in patients with atrial fibrillation (AF) until their INR levels are in therapeutic range. Using a hospital database, we compared AF patients C65 years who were bridged (n = 265) with patients who were not bridged (n = 4532) after hospital discharge. Patients who failed to achieve a therapeutic INR within 30 days were excluded. CHADS2 scores (congestive heart failure, hypertension, age C75, diabetes, stroke), bleeding risk and co-morbidity scores were assessed. Unadjusted and adjusted odds ratios for outcome events (death, stroke, hemorrhage and venous thromboembolism (VTE) within 30 days of discharge were compared. Bridged patients, as compared to those not bridged, were younger (74.7 ± 6.6 vs. 78.5 ± 7.7 years), less likely to be white (36 vs. 51%), and less likely to have CHADS2 scores ≥2 (67 vs. 84%), all P<0.001. There was no significant difference in bleeding risk (bridged vs. not bridged: 1.5 ± 7 vs. 1.7 ± 6). In logistic models adjusting for age, white race, bleeding risk, CHADS 2 and Comorbidity scores, bridging was significantly associated with lower mortality and a decreased odds ratio for VTE (both P<0.01) but not for stroke or hemorrhage (both P>0.80). Although we found insufficient evidence of either lower stroke or greater bleeding risk with bridging, our data suggest the possibility that LMWH bridging in patients with AF is associated with lower risks of VTE and death within 30 days of discharge.
KW - Atrial fibrillation
KW - Bridging anticoagulation
KW - CHADS
KW - Venous thromboembolism
KW - Warfarin
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U2 - 10.1007/s11239-010-0470-8
DO - 10.1007/s11239-010-0470-8
M3 - Article
C2 - 20405168
AN - SCOPUS:80053386171
SN - 0929-5305
VL - 30
SP - 479
EP - 485
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
IS - 4
ER -