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Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures
Nathan P Clark1, Daniel M Witt2, Loren E Davies3
1Department of Pharmacy, Kaiser Permanente Colorado, Aurora2Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora.
JAMA Internal Medicine
|May 27, 2015
Summary
Bridge therapy during warfarin interruption for procedures increases bleeding risk without reducing recurrent venous thromboembolism (VTE). Most patients with a history of VTE may not need bridge therapy for secondary prevention.
Area of Science:
- Cardiology
- Hematology
- Clinical Pharmacology
Background:
- Long-term warfarin sodium therapy is used for secondary prevention of venous thromboembolism (VTE).
- Temporary interruption of warfarin is often necessary for surgical or invasive procedures.
- The risks associated with interrupting warfarin and using bridge therapy are not well-defined.
Purpose of the Study:
- To determine the rates of bleeding and recurrent VTE in patients undergoing invasive procedures with interrupted warfarin therapy.
- To compare these outcomes between patients who received bridge therapy and those who did not.
Main Methods:
- Retrospective cohort study at Kaiser Permanente Colorado (2006-2012).
- Included 1178 patients undergoing 1812 procedures with warfarin interruption.
- Compared outcomes (bleeding, VTE recurrence, mortality) between bridge therapy and no bridge therapy groups.
Main Results:
- Bridge therapy was associated with a significantly higher rate of clinically relevant bleeding (2.7% vs 0.2%).
- No significant difference in recurrent VTE rates was observed between groups (0 vs 3 events).
- All-cause mortality was not different between the groups.
Conclusions:
- Bridge therapy during warfarin interruption for invasive procedures increases bleeding risk.
- Bridge therapy is likely unnecessary for most patients with a history of VTE undergoing procedures.
- Further research should identify patient and procedure factors associated with high VTE recurrence risk during warfarin interruption.
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