Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review.

Baumgartner, Christine; de Kouchkovsky, Ivan; Whitaker, Evans; Fang, Margaret C (2019). Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review. The American journal of medicine, 132(6), 722-732.e7. Elsevier 10.1016/j.amjmed.2019.01.004

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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 non-randomized 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 and/or non-major 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 to VKA interruption without bridging, without a significant difference in periprocedural venous thromboembolism rates.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Baumgartner, Christine

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1555-7162

Publisher:

Elsevier

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

14 Feb 2019 07:19

Last Modified:

17 Jan 2020 02:30

Publisher DOI:

10.1016/j.amjmed.2019.01.004

PubMed ID:

30659809

Uncontrolled Keywords:

Anticoagulants Bleeding Bridging PROSPERO Periprocedural Venous thromboembolism registration number CRD42017074710

BORIS DOI:

10.7892/boris.124856

URI:

https://boris.unibe.ch/id/eprint/124856

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