5 years ago

Predictors of Perioperative Major Bleeding in Patients who interrupt Warfarin for an Elective Surgery or Procedure: Analysis of the BRIDGE Trial

The use of low-molecular-weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. Methods BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37days post-procedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. Results We analyzed 1813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6years and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0days (interquartile range: 4.0–18.0days) post-procedure. Bridge therapy was a baseline predictor of major bleeding (odds ratio [OR]=2.4; 95% confidence interval [CI]: 1.2–4.8), as was a history of renal disease (OR=2.9; 95% CI: 1.4–6.0), and high bleeding risk procedures (vs. low bleeding risk procedures) (OR=2.9; 95% CI: 1.4–5.9). Perioperative aspirin use (OR=3.6; 95% CI: 1.1–11.9) and post-procedure INR >3.0 (OR=2.1; 95%CI: 1.5–3.1) were time-dependent predictors of major bleeding. Major bleeding was most common in the first 10days compared to 11–37days post-procedure (OR=3.5; 95% CI: 1.8–6.9). Conclusions In addition to bridge therapy, perioperative aspirin use, post-procedure INR >3.0, a history of renal failure, and having a high bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317302892

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