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Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients: a multicenter propensity-matched analysis

Authors
 T H Kim  ;  J Y Kim  ;  H S Mun  ;  H Y Lee  ;  Y H Roh  ;  J S Uhm  ;  H N Pak  ;  M H Lee  ;  B Joung 
Citation
 JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Vol.13(2) : 182-190, 2015 
Journal Title
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
ISSN
 1538-7933 
Issue Date
2015
MeSH
Administration, Oral ; Aged ; Anticoagulants/administration & dosage* ; Anticoagulants/adverse effects* ; Atrial Fibrillation/blood ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy* ; Chi-Square Distribution ; Female ; Hemorrhage/chemically induced* ; Heparin/administration & dosage* ; Heparin/adverse effects* ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/prevention & control ; Taiwan ; Tertiary Care Centers ; Time Factors ; Treatment Outcome ; Warfarin/administration & dosage* ; Warfarin/adverse effects*
Keywords
atrial fibrillation ; hemorrhage ; heparin ; stroke ; warfarin
Abstract
BACKGROUND: The efficacy of heparin-bridging therapy during the initiation of oral anticoagulation therapy (OAC) in non-valvular atrial fibrillation (NVAF) is unclear. OBJECTIVES: To evaluate the efficacy and the safety of heparin-bridging therapy during OAC initiation in NVAF patients. PATIENTS/METHODS: This study included 5327 consecutive warfarin-naïve NVAF patients who received OAC that was initiated with (n = 1053) or without (n = 4274) heparin bridging at four tertiary hospitals. Stroke and bleeding events within 30 days of OAC were evaluated. RESULTS: While there was no difference in the incidence of stroke (0.5% vs. 0.3%, P = 0.381), major bleeding rate (0.9% vs. 0.3%, P = 0.004) was higher in heparin-bridged than in non-bridged patients. This trend remained in the propensity score-matched population (stroke 0.5% vs. 0.6%, P = 0.762; major bleeding 0.8% vs. 0.1%, P = 0.019). A high CHA2 DS2 -VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2 DS2 -VASc scores. The HAS-BLED score had a predictive value for major bleeding (odds ratio 1.80, 95% confidence interval 1.11-2.92, P = 0.018), and heparin-bridging therapy was associated with a higher major bleeding rate (odds ratio 4.44, 95% confidence interval 1.68-11.72, P = 0.003), especially in patients with a HAS-BLED score of ≥ 1. CONCLUSIONS: The heparin-bridging therapy increased bleeding without the benefit of preventing stroke at the initiation of OAC in NVAF. Our data suggest that heparin bridging should not be considered at the initiation of OAC in NVAF patients.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/jth.12810/abstract
DOI
10.1111/jth.12810
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Roh, Yun Ho(노윤호)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139760
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