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Warfarin bridge therapy ups bleeding risk, with no reduction in VTE

Key clinical point: Bridge therapy for warfarin patients undergoing invasive therapy is associated with an increased risk of bleeding without a reduction in thromboembolism risk.

Major finding: Patients given bridge therapy during invasive therapy had a 17-fold increase in the risk of clinically significant bleeding.

Data source: A retrospective cohort study of 1,812 procedures in 1,178 patients.

Disclosures: The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with AstraZeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.

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Bridging anticoagulation only for high-risk patients

Dr. Daniel J. Brotman

There are undoubtedly some patients at such high risk for recurrent venous thromboembolism that bridge therapy is a necessary evil, such as those with acute VTE in the preceding month and those with a prior pattern of brisk VTE recurrence during short-term interruption of anticoagulation therapy.

However, for the vast majority of patients receiving oral anticoagulants for VTE, it is probably safer to simply allow the oral anticoagulant to wash out before the procedure and, if indicated based on the type of surgery, to use routine prophylactic-dose anticoagulation therapy afterward.

Dr. Daniel J. Brotman and Dr. Michael B. Streiff are from Johns Hopkins University, Baltimore. These comments are taken from an accompanying editorial (JAMA Intern. Med. 2015 May 26 [doi:10.1001/jamainternmed.2015.1858]). Dr Streiff declared research funding from Bristol-Myers Squibb and Portola and consultancies for Boehringer-Ingelheim, Daiichi-Sankyo, Eisai, Janssen HealthCare, Pfizer, and Sanofi.


 

References

Bridge therapy for warfarin patients undergoing invasive therapy is unnecessary for most, said investigators who found an increased risk of bleeding associated with the use of short-acting anticoagulant at the time of the procedure.

A retrospective cohort study of 1,812 procedures in 1,178 patients – most of whom were considered to be at low risk of venous thromboembolism recurrence – showed a 17-fold increase in the risk of clinically relevant bleeding in the group that received bridge anticoagulant therapy, compared with the group that didn’t (2.7% vs. 0.2%).

Dr. Thomas Delate

Dr. Thomas Delate

There was, however, no significant difference in the rate of recurrent venous thromboembolism between the bridge-therapy and non–bridge-therapy groups (0 vs. 3), and no deaths were observed in either group, according to an article published online May 26 (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.1843].

“Our results confirm and strengthen the findings of those previous studies and highlight the need for a risk categorization scheme that identifies patients at highest risk for recurrent VTE who may benefit from bridge therapy,” wrote Thomas Delate, Ph.D., from Kaiser Permanente Colorado, and coauthors.

The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with Astra-Zeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.

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