Abstract 13124: No Clinical Benefit of Heparin Bridging at the Initiation of Anticoagulation Therapy in Nonvalvular Atrial Fibrillation Patients: A Multicenter Propensity-matched Analysis
Introduction: The clinical benefit of heparin bridging therapy during the oral anticoagulant (OAC) therapy initiation in NVAF is unclear. This multicenter propensity score-matched study evaluated the efficacy and the safety of heparin bridging therapy during warfarin therapy initiation in NVAF patients.
Methods: This study included 5,271 consecutive warfarin-naïve NVAF patients that received OAC which was initiated with (n = 1,033) or without (n = 4,238) heparin bridging at four tertiary hospitals. Stroke and bleeding events within 30 days of OAC were evaluated.
Results: Heparin bridged patients had lower proportion of male (54.4% vs. 66.4%, p=0.001), and had higher CHADS2 (1.52±1.22 vs. 1.41±1.18, p=0.010) and CHA2DS2 VASc score (2.60±1.57 vs. 2.38±1.53, p<0.001), and lower HAS-BLED score (0.85±0.78 vs. 1.33±0.92, p<0.001) than non-bridged patients. While there was no difference in the incidence of stroke (0.5% vs. 0.3%, p=0.381), all bleeding rate (1.6% vs. 0.8%, p=0.013) and major bleeding rate (0.9% vs. 0.3%, p=0.004) were higher in heparin-bridged than non-bridged patients. This trend remained in the propensity score-matched population (stroke 0.4% vs. 0.8%, p=0.247; major bleeding 0.9% vs. 0.1%, p=0.011). Multiple logistic regression analysis for outcome events indicated that a high CHA2DS2-VASc score was an independent predictor for stroke, whereas bridging therapy had no beneficial effect in preventing stroke regardless of CHADS2 or CHA2DS2-VASc scores. The HAS-BLED score had a predictive value for major bleeding (OR 1.80, 95% CI 1.11 - 2.92, p=0.018), and heparin bridging therapy was significantly associated with a higher major bleeding rate (OR 4.44, 95% CI 1.68 - 11.72, p=0.003), especially in patients with a HAS-BLED score of 1 or more.
Conclusions: The heparin bridging therapy increased bleeding without the benefit of preventing stroke at OAC initiation in NVAF. Our data suggest that heparin bridging should not be considered at OAC initiation in NVAF patients without high stroke risk.
Author Disclosures: T. Kim: None. J. Kim: None. H. Moon: None. H. Lee: None. J. Uhm: None. H. Pak: None. M. Lee: None. B. Joung: None.
- © 2014 by American Heart Association, Inc.