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

T. H. Kim, J. Y. Kim, H. S. Mun, H. Y. Lee, Y. H. Roh, J. S. Uhm, huinam pak, M. H. Lee, Boyoung Joung

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Summary: 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 CHA2DS2-VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2DS2-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.

Original languageEnglish
Pages (from-to)182-190
Number of pages9
JournalJournal of Thrombosis and Haemostasis
Volume13
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1

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Warfarin
Atrial Fibrillation
Heparin
Hemorrhage
Stroke
Therapeutics
Odds Ratio
Confidence Intervals
Propensity Score
Tertiary Care Centers
Safety

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

@article{adf4221309ac4f09a8a8f65352e89189,
title = "Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients: A multicenter propensity-matched analysis",
abstract = "Summary: 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-na{\"i}ve 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 CHA2DS2-VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2DS2-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.",
author = "Kim, {T. H.} and Kim, {J. Y.} and Mun, {H. S.} and Lee, {H. Y.} and Roh, {Y. H.} and Uhm, {J. S.} and huinam pak and Lee, {M. H.} and Boyoung Joung",
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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. / Kim, T. H.; Kim, J. Y.; Mun, H. S.; Lee, H. Y.; Roh, Y. H.; Uhm, J. S.; pak, huinam; Lee, M. H.; Joung, Boyoung.

In: Journal of Thrombosis and Haemostasis, Vol. 13, No. 2, 01.02.2015, p. 182-190.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients

T2 - A multicenter propensity-matched analysis

AU - Kim, T. H.

AU - Kim, J. Y.

AU - Mun, H. S.

AU - Lee, H. Y.

AU - Roh, Y. H.

AU - Uhm, J. S.

AU - pak, huinam

AU - Lee, M. H.

AU - Joung, Boyoung

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Summary: 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 CHA2DS2-VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2DS2-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.

AB - Summary: 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 CHA2DS2-VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2DS2-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.

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