Periop Bridging Unnecessary for Most A-Fib Patients on Warfarin
Arterial thromboembolism risk doesn't appear to rise without additional drug treatment
THURSDAY, Aug. 27, 2015 (HealthDay News) -- For most atrial fibrillation patients taking warfarin who require temporary interruption for a procedure, perioperative bridging with heparin is unnecessary, according to a study published in the Aug. 27 issue of the New England Journal of Medicine.
Thomas Ortel, M.D., Ph.D., of the Duke University Medical Center in Durham, N.C., and colleagues conducted a study involving 1,884 patients who were having elective surgery or other invasive procedures and were taking warfarin to treat atrial fibrillation. The team randomly assigned patients to take either heparin or an inactive placebo during that time window.
The researchers found that in the end, heparin showed no effect on arterial thromboembolism risk. Just 0.3 percent of treated patients experienced an arterial thromboembolism event within a month of their procedure, versus 0.4 percent of patients given the placebo. On the other hand, heparin did boost the odds of serious bleeding. Just over 3 percent of patients developed major bleeding, compared with just over 1 percent of placebo patients.
"For patients with atrial fibrillation who require temporary interruption of warfarin treatment for an elective operation or other elective invasive procedure, a strategy of forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism," the authors write. "The strategy of forgoing bridging treatment also decreased the risk of major bleeding."
Several authors disclosed financial ties to pharmaceutical companies.