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Guideline compliance for bridging anticoagulation use in vitamin-K antagonist patients; practice variation and

M J Moesker1, J F de Groot2, N L Damen3

  • 11Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081BT Amsterdam, The Netherlands.

Thrombosis Journal
|August 9, 2019
PubMed

Insights

Bridging anticoagulation for vitamin-K antagonist patients undergoing procedures showed significant guideline non-compliance. Individual risk factors, not aggregated guideline risk, influenced clinical decisions, highlighting a need for improved practice.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Practice Guidelines

Background:

  • Bridging anticoagulation is a complex process for patients on vitamin-K antagonists (VKAs) requiring invasive procedures.
  • It involves intricate risk assessment to prevent both thromboembolic events and bleeding complications.

Purpose of the Study:

  • To evaluate adherence to established guidelines for bridging anticoagulation in VKA patients.
  • To identify factors influencing the decision to use bridging anticoagulation, particularly non-compliant practices.

Main Methods:

  • A retrospective analysis of 256 patient records across 13 Dutch hospitals.
  • Data collected included demographics, clinical details, surgical factors, and care delivery characteristics.
  • Compliance with the American College of Chest Physicians ninth edition guideline (AT9) was assessed using multilevel regression models.

Main Results:

  • Bridging anticoagulation use varied widely between hospitals (15.0%–83.3%), with guideline compliance also differing significantly (20.0%–88.2%).
  • Factors beyond aggregated thromboembolic risk, such as gastrointestinal or vascular surgery and non-elective procedures, predicted bridging use.
  • Lower socioeconomic status and VKA reversal agent use were associated with reduced bridging.

Conclusions:

  • Approximately 31.5% of patients did not receive bridging anticoagulation compliant with AT9 guidelines.
  • Individual thromboembolic risk factors and other clinical characteristics were more influential in decision-making than the AT9 aggregated risk.
  • Significant heterogeneity in guideline implementation across hospitals necessitates further research and interventions to optimize bridging anticoagulation practices.
Abstract

Keywords:
AnticoagulantsCoumarinsPerioperative carePractice guidelineQuality of healthcare

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