Parenteral Bridging Practices and Outcomes in Patients on Warfarin for Mechanical Heart Valves and Venous Thromboembolism
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
Research and Practice in Thrombosis and Haemostasis
Abstract
Introduction: Bridging with heparin or low-molecular-weight heparin (LMWH) during warfarin interruption is common. Guidelines against bridging in atrial fibrillation have recently been strengthened, while the evidence against bridging in mechanical heart valves (MHV) and venous thromboembolism (VTE) is less robust. Our objective was to describe the prevalence of bridging in patients on warfarin for MHV or VTE and study post-procedure outcomes. Methods: Patients within the Michigan Anticoagulation Quality Improvement Initiative (MAQI2 ) registry who were prescribed warfarin solely for MHV or VTE between January 1st, 2020 and July 16th, 2024 with at least one interruption for a surgery or invasive procedure and having at least thirty days of post-procedure follow-up were identified. Interruptions were categorized as bridged or non-bridged. Thirty-day post-procedure bleeding and thrombotic event rates were compared using propensity score matching and then adjusted for unbalanced variables. Patient-level clustering was addressed with a generalized estimating equation approach. Major bleeding defined by International Society on Thrombosis and Haemostasis criteria. Results: 530 patients experienced 775 interruptions, and 427 (55.1%) interruptions were bridged. In 293 matched interruptions, thirty-day post-procedure thrombotic events were comparable between bridged and non-bridged interruptions (1.3 vs 2.7 per 100 interruptions, p=0.40) while major bleeding was also similar (2.7 vs 1.3 per 100 interruptions, p=0.23). Total bleeds of any severity and bleeds requiring ED evaluation/treatment were more common after bridged interruptions (12.8 vs 6.1 per 100 interruptions, p=0.015 and 5.1 vs 1.7 per 100 interruptions, p=0.019, respectively). Conclusion: Bridging was associated with a significant increase in bleeding, without a reduction in thrombotic events during the 30-day post-procedure period.
Volume
9
Issue
Suppl 1
First Page
102793
Last Page
102793
Recommended Citation
Tang R, Kong X, Haymart B, Gredell A, Kaatz S, Krol G, et al. [Ali M]. Parenteral bridging practices and outcomes in patients on warfarin for mechanical heart valves and venous thromboembolism. Res Pract Thromb Haemost. 2025 May;9(Suppl1):102793. doi: 10.1016/j.rpth.2025.102793
DOI
10.1016/j.rpth.2025.102793
Comments
Anticoagulation Forum 18th National Conference on Anticoagulation Therapy, April 3-5, 2025, Washington, DC