Predictive Factors and Clinical Events Associated with Edoxaban Interruption and Heparin Bridging Strategy:...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Edoxaban interruption is common for procedures.
• Heparin bridging is frequently used despite not being recommended.
• The efficacy and safety of heparin bridging during edoxaban interruption are unclear.

Purpose of the Study:

• To identify factors predicting edoxaban interruption and heparin bridging.
• To evaluate clinical events, including bleeding and thromboembolism, associated with heparin bridging.
• To understand the rationale behind clinicians' decisions to use heparin bridging.

Main Methods:

• Prospective, noninterventional study (Global EMIT-AF/VTE).
• Inclusion of adult patients with atrial fibrillation or venous thromboembolism on edoxaban undergoing procedures.
• Collection of data on edoxaban interruption, heparin bridging, and clinical events.

Main Results:

• Edoxaban was interrupted in 58.5% of procedures.
• Heparin bridging was used in 14.6% of interruptions.
• Higher HAS-BLED scores and high EHRA procedural risk predicted interruption and bridging; CHA2DS2-VASc scores did not.
• Heparin bridging was associated with higher bleeding rates (6.2% vs 3.1%) but not lower thromboembolic risk.

Conclusions:

• Periprocedural heparin use in edoxaban interruption is linked to increased bleeding.
• Bleeding risk factors, rather than stroke risk, appear to drive the decision to use heparin bridging.
• Current practice may not align with recommended guidelines regarding heparin bridging during edoxaban interruption.