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Forgoing Bridging Anticoagulation Noninferior in A-Fib

Findings in patients with atrial fibrillation undergoing elective operation, invasive procedure

MONDAY, June 22, 2015 (HealthDay News) -- Forgoing bridging anticoagulation therapy is noninferior to bridging with low-molecular-weight heparin in patients with atrial fibrillation undergoing an elective operation or invasive procedure. The finding was published online June 22 in the New England Journal of Medicine to coincide with the International Society on Thrombosis and Haemostasis 2015 Congress, held from June 20 to 25 in Toronto.

James D. Douketis, M.D., from St. Joseph's Healthcare Hamilton in Canada, and colleagues performed a randomized, placebo-controlled trial in which patients were randomized to receive bridging anticoagulation therapy with low-molecular-weight heparin (934 patients) or matching placebo (950 patients) after perioperative interruption of warfarin therapy. Warfarin treatment was stopped five days before and resumed within 24 hours after the procedure. Patients were followed for 30 days after the procedure.

The researchers found that the incidence of arterial thromboembolism was 0.4 and 0.3 percent in the no-bridging and bridging groups, respectively (difference, 0.1 percentage points; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3 and 3.2 percent in the no-bridging and bridging groups, respectively (relative risk, 0.41; P = 0.005 for superiority).

"In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding," the authors write.

The active drug was supplied by Eisai; the University of Iowa pharmaceuticals provided the matching placebo, and Live Oak Pharmaceuticals Consulting provided relevant consultancy.

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