Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in nonvalvular atrial fibrillation patients: A multicenter propensity-matched analysis.
J Thromb Haemost. 2014 Dec 4;
Authors: Kim TH, Kim JY, Mun HS, Lee HY, Roh YH, Uhm JS, Pak HN, Lee MH, Joung B
BACKGROUND: The efficacy of heparin bridging therapy during the initiation of oral anticoagulation therapy (OAC) in nonvalvular 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 5,327 consecutive warfarin-naïve NVAF patients who received OAC which was initiated with (n = 1,053) or without (n = 4,274) 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 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 (OR 1.80, 95% CI 1.11 - 2.92, p=0.018), and heparin bridging therapy was associated with a higher major bleeding rate (OR 4.44, 95% CI 1.68 - 11.72, p=0.003), especially in patients with a HAS-BLED score of 1 or more.
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. This article is protected by copyright. All rights reserved.
PMID: 25472735 [PubMed - as supplied by publisher]