The effect of heparin infusion intensity on outcomes for bridging hospitalized patients with atrial fibrillation

Abstract

Background Perioperative bridging in atrial fibrillation (AF) is associated with low thromboembolic rates but high bleeding rates. Recent guidance cautions the practice of bridging except in high risk patients. However, the practice of bridging varies widely and little data exist regarding appropriate anticoagulation intensity when using intravenous unfractionated heparin (UFH). Hypothesis To determine if high intensity UFH infusion regimens are associated with increased bleeding rates compared to low intensity regimens for bridging patients with AF. Methods We conducted a single center retrospective cohort study of admitted patients with non‐valvular AF receiving UFH for ≥24 hours. UFH intensities were chosen at the providers' discretion. The primary endpoint was the rate of bleeding defined by the International Society on Thrombosis and Hemostasis during UFH infusion or within 24 hours of discontinuation. The secondary endpoint was a composite of cardiovascular events, arterial thromboembolism, venous thromboembolism, myocardial infarctions and death during UFH infusion. Results A total of 497 patients were included in this analysis. Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of patients. The rate of any bleed was higher among high intensity compared to low intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval = 1.07‐4.90). Major bleeding was significantly higher among high intensity compared to low intensity UFH regimens. There was no difference in composite thrombotic events or death. Conclusions Low intensity UFH infusions, targeting lower anticoagulation targets, were associated with decreased bleeding rates without a signal of increased thromboembolic events in hospitalized AF patients.

Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure

“…AF is associated with a 4- to fivefold increased risk of ischemic stroke. The annual stroke risk in patients with AF ranges from 0.5% to 9.3%, and approximately 15% of ischemic strokes are attributed to AF [ 43 , 44 ]. Chronic AF often remains asymptomatic and can go undetected in clinical practice, resulting in an underestimation of stroke risk.…”

Keamanan Penggunaan Antiglukolan pada Pasien Rawat Inap Stroke Iskemik dengan Atrial Fibrilasi

“…Study meta-analisis oleh Paciaroni et al, melaporkan penggunaan antikoagulan (unfractionated heparin, low-molecular-weight heparin dan heparinoid) pada pasien stroke kardioemboli terjadi peningkatan risiko perdarahan yang signifikan 42 . Penelitian lain menyebutkan bahwa perdarahan mayor secara signifikan lebih tinggi diantara highintensity dibandingkan dengan low-intensity unfractionated heparin 43 .…”