The effect of heparin infusion intensity on outcomes for bridging hospitalized patients with atrial fibrillation

Bruce A. Warden, Calvin Diep, Ran Ran, Matthew Thomas, Joaquin Cigarroa

    Research output: Contribution to journalArticle

    Abstract

    Background: Perioperative bridging in atrial fibrillation (AF) is associated with low thromboembolic rates but high bleeding rates. Recent guidance cautions the practice of bridging except in high risk patients. However, the practice of bridging varies widely and little data exist regarding appropriate anticoagulation intensity when using intravenous unfractionated heparin (UFH). Hypothesis: To determine if high intensity UFH infusion regimens are associated with increased bleeding rates compared to low intensity regimens for bridging patients with AF. Methods: We conducted a single center retrospective cohort study of admitted patients with non-valvular AF receiving UFH for ≥24 hours. UFH intensities were chosen at the providers' discretion. The primary endpoint was the rate of bleeding defined by the International Society on Thrombosis and Hemostasis during UFH infusion or within 24 hours of discontinuation. The secondary endpoint was a composite of cardiovascular events, arterial thromboembolism, venous thromboembolism, myocardial infarctions and death during UFH infusion. Results: A total of 497 patients were included in this analysis. Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of patients. The rate of any bleed was higher among high intensity compared to low intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval = 1.07-4.90). Major bleeding was significantly higher among high intensity compared to low intensity UFH regimens. There was no difference in composite thrombotic events or death. Conclusions: Low intensity UFH infusions, targeting lower anticoagulation targets, were associated with decreased bleeding rates without a signal of increased thromboembolic events in hospitalized AF patients.

    Original languageEnglish (US)
    JournalClinical Cardiology
    DOIs
    StateAccepted/In press - Jan 1 2019

    Fingerprint

    Atrial Fibrillation
    Heparin
    Hemorrhage
    Thromboembolism
    Venous Thromboembolism
    Warfarin
    Hemostasis
    Anticoagulants
    Thrombosis
    Cohort Studies
    Retrospective Studies
    Odds Ratio
    Myocardial Infarction
    Confidence Intervals

    Keywords

    • anticoagulation
    • atrial fibrillation
    • bleeding
    • bridging
    • heparin
    • thrombosis

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    The effect of heparin infusion intensity on outcomes for bridging hospitalized patients with atrial fibrillation. / Warden, Bruce A.; Diep, Calvin; Ran, Ran; Thomas, Matthew; Cigarroa, Joaquin.

    In: Clinical Cardiology, 01.01.2019.

    Research output: Contribution to journalArticle

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    N2 - Background: Perioperative bridging in atrial fibrillation (AF) is associated with low thromboembolic rates but high bleeding rates. Recent guidance cautions the practice of bridging except in high risk patients. However, the practice of bridging varies widely and little data exist regarding appropriate anticoagulation intensity when using intravenous unfractionated heparin (UFH). Hypothesis: To determine if high intensity UFH infusion regimens are associated with increased bleeding rates compared to low intensity regimens for bridging patients with AF. Methods: We conducted a single center retrospective cohort study of admitted patients with non-valvular AF receiving UFH for ≥24 hours. UFH intensities were chosen at the providers' discretion. The primary endpoint was the rate of bleeding defined by the International Society on Thrombosis and Hemostasis during UFH infusion or within 24 hours of discontinuation. The secondary endpoint was a composite of cardiovascular events, arterial thromboembolism, venous thromboembolism, myocardial infarctions and death during UFH infusion. Results: A total of 497 patients were included in this analysis. Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of patients. The rate of any bleed was higher among high intensity compared to low intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval = 1.07-4.90). Major bleeding was significantly higher among high intensity compared to low intensity UFH regimens. There was no difference in composite thrombotic events or death. Conclusions: Low intensity UFH infusions, targeting lower anticoagulation targets, were associated with decreased bleeding rates without a signal of increased thromboembolic events in hospitalized AF patients.

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