Low molecular weight heparin bridging for atrial fibrillation: Is VTE thromboprophylaxis the major benefit?

Henny H. Billett, Barbara A. Scorziello, Emily R. Giannattasio, Hillel W. Cohen

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)479-485
Number of pages7
JournalJournal of Thrombosis and Thrombolysis
Volume30
Issue number4
DOIs
StatePublished - Nov 2010

Fingerprint

Low Molecular Weight Heparin
Venous Thromboembolism
Atrial Fibrillation
International Normalized Ratio
Stroke
Hemorrhage
Odds Ratio
Heart Failure
Databases
Hypertension
Morbidity
Therapeutics

Keywords

  • Atrial fibrillation
  • Bridging anticoagulation
  • CHADS
  • Venous thromboembolism
  • Warfarin

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Low molecular weight heparin bridging for atrial fibrillation : Is VTE thromboprophylaxis the major benefit? / Billett, Henny H.; Scorziello, Barbara A.; Giannattasio, Emily R.; Cohen, Hillel W.

In: Journal of Thrombosis and Thrombolysis, Vol. 30, No. 4, 11.2010, p. 479-485.

Research output: Contribution to journalArticle

Billett, Henny H. ; Scorziello, Barbara A. ; Giannattasio, Emily R. ; Cohen, Hillel W. / Low molecular weight heparin bridging for atrial fibrillation : Is VTE thromboprophylaxis the major benefit?. In: Journal of Thrombosis and Thrombolysis. 2010 ; Vol. 30, No. 4. pp. 479-485.
@article{ef846dacfb1d4450994cde6c475a8815,
title = "Low molecular weight heparin bridging for atrial fibrillation: Is VTE thromboprophylaxis the major benefit?",
abstract = "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.",
keywords = "Atrial fibrillation, Bridging anticoagulation, CHADS, Venous thromboembolism, Warfarin",
author = "Billett, {Henny H.} and Scorziello, {Barbara A.} and Giannattasio, {Emily R.} and Cohen, {Hillel W.}",
year = "2010",
month = "11",
doi = "10.1007/s11239-010-0470-8",
language = "English (US)",
volume = "30",
pages = "479--485",
journal = "Journal of Thrombosis and Thrombolysis",
issn = "0929-5305",
publisher = "Springer Netherlands",
number = "4",

}

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.

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

UR - http://www.scopus.com/inward/record.url?scp=80053386171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053386171&partnerID=8YFLogxK

U2 - 10.1007/s11239-010-0470-8

DO - 10.1007/s11239-010-0470-8

M3 - Article

C2 - 20405168

AN - SCOPUS:80053386171

VL - 30

SP - 479

EP - 485

JO - Journal of Thrombosis and Thrombolysis

JF - Journal of Thrombosis and Thrombolysis

SN - 0929-5305

IS - 4

ER -