Periprocedural heparin bridging in patients receiving oral anticoagulation: a systematic review and meta-analysis

Abstract

BackgroundPeriprocedural heparin bridging therapy aims to reduce the risk of thromboembolic events in patients requiring an interruption in their anticoagulation therapy for the purpose of an elective procedure. The efficacy and safety of heparin bridging therapy has not been well established.ObjectivesTo compare through meta-analysis the effects of heparin bridging therapy on the risk of major bleeding and thromboembolic events of clinical significance among patients taking oral anticoagulants.MethodsWe searched PubMed, EMBASE and the Cochrane library from January 2005 to July 2016. Studies were included if they reported clinical outcomes of patients receiving heparin bridging therapy during interruption of oral anticoagulant for operations. Data were pooled using random-effects modeling.ResultsA total of 25 studies, including 6 randomized controlled trials and 19 observational studies, were finally included in this analysis. Among all the 35,944 patients, 10,313 patients were assigned as heparin bridging group, and the other 25,631 patients were non-heparin bridging group. Overall, compared with patients without bridging therapy, heparin bridging therapy increased the risk of major bleeding (OR = 3.23, 95%CI: 2.06–5.05), minor bleeding (OR = 1.52, 95%CI: 1.06–2.18) and overall bleeding (OR = 2.83, 95%CI: 1.86–4.30).While there was no significant difference in thromboembolic events (OR = 0.99,95%CI: 0.49–2.00), stroke or transient ischemic attack(OR = 1.45, 95%CI: 0.93–2.26,) or all-cause mortality (OR = 0.71, 95%CI: 0.31–1.65).ConclusionsHeparin-bridging therapy increased the risk of major and minor bleeding without decreasing the risk of thromboembolic events and all cause death compared to non-heparin bridging.

Thromboembolic and bleeding risk of periprocedural bridging anticoagulation: A systematic review and meta‐analysis

“…In this study, we critically selected relevant studies and conducted a rigorously scientific synthesis of research results. Prior meta‐analyses evaluating the risk and benefit of bridging anticoagulation are flawed with inclusions of few randomized trials and studies with no control arm, no separate analysis of three strategies (interrupted anticoagulation with bridging therapy, interrupted anticoagulation without bridging therapy and continuous oral anticoagulation), and no detailed assessment of study quality . We found that bridging anticoagulation was associated with higher bleeding risk and similar thromboembolic risk compared to non‐bridging strategy.…”

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

“…[5657] In a recent meta-analysis of 25 studies ( n = 35,944), bridging therapy did not reduce thromboembolic events and actually led to increased risk of overall and major bleeding. [58] Thus, bridging therapy with LMWH seems to be efficacious only in patients at high risk of thrombosis.…”

Bleeding disorders in implant dentistry: a narrative review and a treatment guide

“…Here, bridging led significantly more often to bleeding events (odds ratio [OR]: relevant bleeding 3.23; OR minor bleeding 1.52). Between the two groups, no differences in thromboembolic events were observed [ 84 ].…”