Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun;132(6):722-732.e7.
doi: 10.1016/j.amjmed.2019.01.004. Epub 2019 Jan 16.

Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review

Christine Baumgartner  1 , Ivan de Kouchkovsky  2 , Evans Whitaker  3 , Margaret C Fang  4
Affiliations

Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review

Christine Baumgartner et al. Am J Med. 2019 Jun.

Abstract

Background: Vitamin K antagonists (VKA) are the most widely used anticoagulants, and bridging is commonly administered during periprocedural VKA interruption. Given the unclear benefits and risks of periprocedural bridging in patients with previous venous thromboembolism, we aimed to assess recurrent venous thromboembolism and bleeding outcomes with and without bridging in this population.

Methods: We performed a systematic review searching the PubMed and Embase databases from inception to December 7, 2017 for randomized and nonrandomized studies that included adults with previous venous thromboembolism requiring VKA interruption to undergo an elective procedure, and that reported venous thromboembolism or bleeding outcomes. Quality of evidence was graded by consensus.

Results: We included 28 cohort studies (20 being single-arm cohorts) with, overall, 6915 procedures for analysis. In 27 studies reporting perioperative venous thromboembolism outcomes, the pooled incidence of recurrent venous thromboembolism with bridging was 0.7% (95% confidence interval [CI], 0.4%-1.2%) and 0.5% (95% CI, 0.3%-0.8%) without bridging. Eighteen studies reported major or nonmajor bleeding outcomes. The pooled incidence of any bleeding was 3.9% (95% CI, 2.0%-7.4%) with bridging and 0.4% (95% CI, 0.1%-1.7%) without bridging. In bridged patients at high thromboembolic risk, the pooled incidence for venous thromboembolism was 0.8% (95% CI, 0.3%-2.5%) and 7.5% (95% CI, 3.1%-17.4%) for any bleeding. Quality of available evidence was very low, primarily due to a high risk of bias of included studies.

Conclusions: Periprocedural bridging increases the risk of bleeding compared with VKA interruption without bridging, without a significant difference in periprocedural venous thromboembolism rates.

Keywords: Anticoagulants; Bleeding; Bridging; PROSPERO; Periprocedural; Venous thromboembolism; registration number CRD42017074710.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study flow diagram. Studies evaluated for inclusion, adapted from PRISMA Statement Flow Diagram. Abbreviations: VKA, vitamin K antagonist. * Until December 7, 2017 † identified through searching of bibliographies and clinical trial databases ‡ refers to duplicate publication (e.g. conference abstract) or studying the same population as another publication § because abstract/publication was not available and results could not be obtained from authors, or study was still ongoing
See this image and copyright information in PMC

Comment in

References

    1. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R and American College of Chest P. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e326S–350S. - PMC - PubMed
    1. Medical Expenditure Panel Survey (MEPS) 2005–2015. Agency for Healthcare Research and Quality (AHRQ), Rockville, MD: ClinCalc DrugStats Database version 18.0 http://clincalc.com/DrugStats/Top300Drugs.aspx, accessed April 11, 2018.
    1. Lippi G, Mattiuzzi C, Cervellin G and Favaloro EJ. Direct oral anticoagulants: analysis of worldwide use and popularity using Google Trends. Annals of translational medicine 2017;5:322. - PMC - PubMed
    1. Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Jr., Ortel TL, Saxonhouse SJ and Spinler SA. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 2017;69:871–898. - PubMed
    1. Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W and Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 2012;126:1630–1639. - PubMed

Publication types

MeSH terms