Abstract 19511: Bridging Therapy in Oral Anticoagulation
Introduction: Low molecular weight heparin is frequently used as bridging therapy (BT) during phases with discontinuation of oral anticoagulation (OAC).
Hypothesis: To provide sex-specific data on frequency and duration of BT, to explore clinical and sociodemographic factors associated with BT, to assess complications.
Methods: We investigated 760 participants from the prospective thrombEVAL study (NCT01809015), treated with OAC in a specialized coagulation service. Data were obtained from medical records, by clinical visits and laboratory data. All information on endpoints was validated via hospital records.
Results: A total of 281,934 days of OAC and 13,065 days of BT were analyzed. Men (m) had less bridging episodes (BE) per year, resulting in 6.2days less BT per year (m: 15.4days of BT/y vs. w: 21.6days of BT/y). BT was applied in 2 out of 3 patients receiving surgery, whereas BT and OAC were equally frequent applied during interventional procedures. Quality of OAC did not differ significantly between patients receiving BT due to medical procedures and those without (p=0.7). Multivariable regression analysis demonstrated an association of BT with patients living in a nursing home (OR 3.0,95%CI 1.4/6.5), presence of care level (OR 2.0,95%CI 1.1/3.6) and a handicapped pass (OR 1.6;95%CI 1.2/2.3) (all p<0.05). Thromboembolic (TE) events showed a rate ratio of 10.3 (95% CI 9.3/11.3) comparing BT and OAC, whereas bleeding showed a rate ratio of 2.7 (95% CI 2.6/2.8). Bleeding events were 8.0 more frequent during BT than TE events. TE events were not associated with BE, whereas bleeding events showed an independent association with ≥1 BE (OR 1.8; 95%CI 1.2/2.4; p<0.001). After adjustment for age, sex and cardiovascular risk factors, sociodemographic factors (handicapped pass: OR 2.2; 95%CI 1.6/3.1; need for home care: OR 1.9; 95%CI 1.1/3.3) and BT (OR 2.1; 95%CI 1.5/3.1) were independently associated with hospitalization (all p<0.05).
Conclusions: In daily clinical practice, bridging therapy is surprisingly frequent and shows sex-specific differences in this cohort. The strong and independent associations of bridging therapy with sociodemographic factors should be considered for future strategies to improve oral anticoagulation treatment regimes.
Author Disclosures: J.H. Prochaska: None. C. Hausner: None. S. Göbel: None. K. Keller: None. M. Coldewey: None. H. Lamparter: None. A. Ullmann: None. H. Schinzel: None. C. Bickel: None. T. Münzel: None. P.S. Wild: None.
- © 2014 by American Heart Association, Inc.