Bridge therapy for warfarin patients undergoing invasive therapy is unnecessary for most, said investigators who found an increased risk of bleeding associated with the use of short-acting anticoagulant at the time of the procedure.
A retrospective cohort study of 1,812 procedures in 1,178 patients – most of whom were considered to be at low risk of venous thromboembolism recurrence – showed a 17-fold increase in the risk of clinically relevant bleeding in the group that received bridge anticoagulant therapy, compared with the group that didn’t (2.7% vs. 0.2%).
Dr. Thomas Delate
There was, however, no significant difference in the rate of recurrent venous thromboembolism between the bridge-therapy and non–bridge-therapy groups (0 vs. 3), and no deaths were observed in either group, according to an article published online May 26 (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.1843].
“Our results confirm and strengthen the findings of those previous studies and highlight the need for a risk categorization scheme that identifies patients at highest risk for recurrent VTE who may benefit from bridge therapy,” wrote Thomas Delate, Ph.D., from Kaiser Permanente Colorado, and coauthors.
The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with Astra-Zeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.