Safety and Efficacy of Bridging with Low Molecular Weight Heparins: A Systematic Review and Partial Meta-Analysis

Eijgenraam, Pieter; Cate, Hugo Ten; Cate‐Hoek, Arina J. ten

doi:10.2174/1381612811319220010

Cited by 24 publications

(17 citation statements)

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“…However, bridging was associated with an increased risk of major bleeding in five studies (OR, 3·60; 95% CI, 1·52–8·50). A further systematic review also concluded ‘while the antithrombotic efficacy of perioperative bridging with LMWH has not been demonstrated, increased bleeding risk is observed in different types of surgery’ (Eijgenraam et al , ).…”

Section: Warfarin and Other Vitamin K Antagonistsmentioning

confidence: 99%

Peri‐operative management of anticoagulation and antiplatelet therapy

2016

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Section: Warfarin and Other Vitamin K Antagonistsmentioning

confidence: 99%

Peri‐operative management of anticoagulation and antiplatelet therapy

2016

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“…113 Because of heterogeneity in comparison groups, the authors limited the meta-analysis to studies on patients having pacemaker or implantable cardioverter defibrillator surgery. In the pooled analysis of six studies that compared patients who continued with a VKA during the procedure with those who received bridging therapy, the risk of bleeding complications was significantly increased with bridging therapy (relative risk 3.03, 1.86 to 4.95).…”

Section: Patients Taking Vkasmentioning

confidence: 99%

Peri-procedural management of patients taking oral anticoagulants

Daniels

2015

BMJ

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The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient's perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.

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“…showed no significant difference in thrombotic rates (0.9% in bridged patients and 0.6% in non-bridged patients), but significantly increased bleeding rates (overall bleeding of 13.1% and major bleeding of 4.2% in bridged patients and 3.4%/0.9% in non-bridged patients, respectively) with an OR of 3.6 for major bleeding in bridged patients [6]. Another recent metaanalysis has shown similar results [4]. However, given the heterogeneity of individual studies and the underrepresentation of high-risk patients, it is possible that bridging is effective in the latter group.…”

Section: The Effectiveness Of Bridgingmentioning

confidence: 69%

“…The uncertainty is related to the lack of randomised controlled trials. There is increasing evidence from systematic reviews and meta-analyses that bridging therapy is associated with an increased risk of bleeding, Whilst the absolute reduction in thrombotic events is uncertain [4][5][6], and because of this various bridging therapy protocols are in use.…”

Section: Introductionmentioning

confidence: 99%

Management of peri‐operative anti‐thrombotic therapy

Veen

Makris

2014

Anaesthesia

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SummaryThe management of antithrombotic therapy in the peri-operative setting is a common problem, balancing haemorrhagic risk with continued treatment and thrombotic risk when discontinued. High-quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. This review discusses the available evidence for the management of patients on warfarin, non-vitamin K antagonist oral anticoagulant drugs, and antiplatelet therapy in the peri-operative setting. Bridging therapy for patients on warfarin should be considered for those at highest risk of thrombosis, whereas it may not be necessary for those on non-vitamin K antagonist oral anticoagulant drugs given the reduced time off anticoagulation and their more predictable pharmacokinetics. Aspirin can be continued for most procedures. Dual antiplatelet agents for patients with a recently inserted coronary artery stent should be continued if possible but decisions should be individualised and taken after multidisciplinary discussion.

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Safety and Efficacy of Bridging with Low Molecular Weight Heparins: A Systematic Review and Partial Meta-Analysis

Abstract: While the antithrombotic efficacy of bridging with LMWH has not been demonstrated, increased bleeding risk is observed in different types of surgery. PM/ICD surgery can be safely performed on continued VKA.

Cited by 24 publications

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Peri‐operative management of anticoagulation and antiplatelet therapy

Peri‐operative management of anticoagulation and antiplatelet therapy

Peri-procedural management of patients taking oral anticoagulants

Management of peri‐operative anti‐thrombotic therapy

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