Effect of Intravenous Heparin Administration on Duration of Hospitalization

Dunn, Andrew; Bioh, Dominic; Beran, Mindy; Capasso, Marco; A, Siu

doi:10.4065/79.2.159

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…As the majority of our patients were treated with weight-adjusted LMWH which is easier to apply on an outpatient basis, the delaying effect of intravenous heparin on hospital duration may have been less significant than reported in other studies [14, 15]. …”

Section: Discussionmentioning

confidence: 65%

“…Bridging of anticoagulation therapy with intravenous heparin has been reported to be associated with an increased duration of hospitalisations for other indications than acute stroke [14, 15]. The purpose of this study was to compare the timing and complication rates of different strategies for initiation of oral anticoagulation after acute stroke or TIA in routine clinical care.…”

Section: Introductionmentioning

confidence: 99%

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Initiation of Oral Anticoagulation after Acute Ischaemic Stroke or Transient Ischaemic Attack: Timing and Complications of Overlapping Heparin or Conventional Treatment

Audebert

Schenk²,

Tietz³

et al. 2008

Cerebrovasc Dis

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Background: Oral anticoagulation is highly effective for secondary prevention of cardioembolic strokes in patients with atrial fibrillation (AF). There are no studies investigating timing and complications of different strategies for initiation of oral anticoagulation after acute stroke or transient ischaemic attack (TIA). Methods: Patients of ten community hospitals participating in the prospective evaluation of medical effects of the Telemedical Project for Integrative Stroke Care (TEMPiS) were included. This observational evaluation was restricted to ischaemic stroke or TIA patients with AF who were started on Phenprocoumon treatment during in-hospital stay. Antithrombotic co-medication was dichotomized in heparin bridging (weight or partial thromboplastin time-adjusted heparin) or conventional treatment (antiplatelets and/or low-dose heparin or nil). Besides treatment-relevant extracranial bleeding, major complications were documented according to the European Atrial Fibrillation Trial definitions including vascular death, ischaemic or haemorrhagic stroke, systemic embolism, and myocardial infarction. Results: Between July 2003 and March 2005, 4,082 ischaemic stroke or TIA patients were admitted. AF was recorded in 961 patients (23.5%), of whom 376 (39.1%) received oral anticoagulation. In 229 of these patients oral anticoagulation was started in hospital, 150 (65.5%) with heparin bridging and 79 (34.5%) with conventional treatment. Patients with heparin bridging were younger, and had a longer in-hospital stay after adjustment for potential confounders (p = 0.01). Major complications were infrequent in both groups (2.0 vs. 2.5%; p = 1.0) as well as extracranial bleeding (3.3 vs. 1.2%; p = 0.43). Conclusions: Initiation of oral anticoagulation after acute ischaemic stroke yielded low complication rates independent of antithrombotic co-medication. Heparin bridging was associated with a longer stay in acute care hospitals.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Initiation of Oral Anticoagulation after Acute Ischaemic Stroke or Transient Ischaemic Attack: Timing and Complications of Overlapping Heparin or Conventional Treatment

Audebert

Schenk²,

Tietz³

et al. 2008

Cerebrovasc Dis

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“…Initiation of antithrombotic therapy is a common indication for hospitalization, while discharge from hospital is frequently delayed by difficulty achieving a therapeutic level of anticoagulation [1]. Patient-administered subcutaneous low-molecular-weight-heparin (LMWH) has been an important advance in antithrombotic therapy because it has eliminated the need for inpatient administration of intravenous heparin, thereby allowing the initiation of warfarin therapy in the outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

The duration of anticoagulation bridging therapy in clinical practice may significantly exceed that observed in clinical trials

Deerhake

Merz

Cooper

et al. 2007

J Thromb Thrombolysis

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The duration of LMWH bridging therapy in practice may be significantly greater than previously reported in clinical trials, and the incidence of patients requiring prolonged (>14 days) LMWH therapy is relatively high. Outpatient LMWH as employed in clinical practice safely bridges patients to oral anticoagulation. Strategies to shorten the duration of LMWH therapy are needed and are likely to improve clinical outcomes and reduce health care expenses. In prospective clinical trials low-molecular-weight-heparin (LMWH) has proven effective in transitioning patients with venous thromboembolic disease to therapeutic warfarin anticoagulation. However, it is unknown if the anticoagulation results obtained in these trials, which involved rigidly performed anticoagulation monitoring, are achieved in standard clinical practice involving patients with a variety of indications for anticoagulation. We conducted a retrospective analysis of 100 patients initiating warfarin while receiving LMWH under the management of a university-based anticoagulation management service. The mean total duration of LMWH therapy was 12.0 +/- 8.2 days, of which 9.8 +/- 8.0 days (median 7.5 days; interquartile range 4.3-13.0 days) occurred in the outpatient setting. Forty-one percent of patients received outpatient LMWH for <7 days, 40% for 7-14 days, and 19% for >14 days. We conclude that the duration of LMWH bridging therapy in practice may be significantly greater than previously reported in clinical trials, and the incidence of patients requiring prolonged (>14 days) LMWH therapy is relatively high.

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“…Briefly, low molecular weight heparin shows more antithrombotic activity and less anticoagulant activity with lower risk of bleeding as a side effect (23). However, pure low molecular weight heparin preparations are difficult to produce and are significantly more expensive than UFH.…”

Section: Discussionmentioning

confidence: 99%