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Safety and Efficacy of Bridging With Low-Molecular-Weight Heparin During Temporary Interruptions of Warfarin: A Register-Based Cohort Study
Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0002-2141-6086
Lund Univ, Skane Univ Hosp, Clin Coagulat Res Unit, Dept Translat Med, Malmo, Sweden..
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2017 (English)In: Clinical and applied thrombosis/hemostasis, ISSN 1076-0296, E-ISSN 1938-2723, Vol. 23, no 8, p. 961-966Article in journal (Refereed) Published
Abstract [en]

Low-molecular-weight heparin (LMWH) is often recommended as a bridging therapy during temporary interruptions in warfarin treatment, despite lack of evidence. The aim of this study was to see whether we could find benefit from LMWH bridging. We studied all planned interruptions of warfarin within the Swedish anticoagulation register Auricula during 2006 to 2011. Low-molecular-weight heparin bridging was compared to nonbridging (control) after propensity score matching. Complications were identified in national clinical registers for 30 days following warfarin cessation, and defined as all-cause mortality, bleeding (intracranial, gastrointestinal, or other), or thrombosis (ischemic stroke or systemic embolism, venous thromboembolism, or myocardial infarction) that was fatal or required hospital care. Of the 14 556 identified warfarin interruptions, 12 659 with a known medical background had a mean age of 69 years, 61% were males, mean CHADS(2) (1 point for each of congestive heart failure, hypertension, age 75 years, diabetes, and 2 points for stroke or transient ischemic attack) score was 1.7, and CHA(2)DS(2)-VASc score was 3.4. The total number of LMWH bridgings was 7021. Major indications for anticoagulation were mechanical heart valve prostheses 4331, atrial fibrillation 1097, and venous thromboembolism 1331. Bridging patients had a higher rate of thrombotic events overall. Total risk of any complication did not differ significantly between bridging (1.5%) and nonbridging (1.2%). Regardless of indication for warfarin treatment, we found no benefit from bridging. The type of procedure prompting bridging was not known, and the likely reason for the observed higher risk of thrombosis with LMWH bridging is that low-risk procedures more often meant no bridging. Results from randomized trials are needed, especially for patients with mechanical heart valves.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC , 2017. Vol. 23, no 8, p. 961-966
Keywords [en]
bridging, low-molecular-weight heparin, dalteparin, enoxaparin, tinzaparin, warfarin
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-337311DOI: 10.1177/1076029617706756ISI: 000412901900009PubMedID: 28468510OAI: oai:DiVA.org:uu-337311DiVA, id: diva2:1172417
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-10Bibliographically approved

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