Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure

James D. Douketis; Jeff S. Healey; Martina Brueckmann; John W. Eikelboom; Michael D. Ezekowitz; Mandy Fraessdorf; Herbert Noack; Jonas Oldgren; Paul Reilly; Alex C. Spyropoulos; Lars Wallentin; Stuart J. Connolly

doi:10.1160/TH14-04-0305

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(03): 625-632
DOI: 10.1160/TH14-04-0305

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure

Substudy of the RE-LY trial

James D. Douketis

¹Department of Medicine, McMaster University, Hamilton, Canada

,

Jeff S. Healey

¹Department of Medicine, McMaster University, Hamilton, Canada

²Population Health Research Institute, McMaster University, Hamilton, Canada

,

Martina Brueckmann

³Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Germany

⁴Medical Faculty Mannheim of the University of Heidelberg, Germany

,

John W. Eikelboom

¹Department of Medicine, McMaster University, Hamilton, Canada

²Population Health Research Institute, McMaster University, Hamilton, Canada

,

Michael D. Ezekowitz

⁵Jefferson Medical College, Wynnewood, Pennsylvania, USA

,

Mandy Fraessdorf

³Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Germany

,

Herbert Noack

³Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Germany

,

Jonas Oldgren

⁶Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden

,

Paul Reilly

⁷Boehringer Ingelheim Pharmaceuticals, Ridgefield, Conneticut, USA

,

Alex C. Spyropoulos

⁸North Shore-Long Island Jewish Health System, Manhasset, New York, USA

,

Lars Wallentin

⁶Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden

,

Stuart J. Connolly

¹Department of Medicine, McMaster University, Hamilton, Canada

²Population Health Research Institute, McMaster University, Hamilton, Canada

› Author Affiliations

Abstract

Summary

In patients with atrial fibrillation (AF) who require interruption of dabigatran or warfarin for an elective surgery/procedure, the risks and benefits of perioperative bridging anticoagulation is uncertain. We accessed the database from RE-LY, a randomised trial comparing dabigatran with warfarin for stroke prevention in AF, to assess the potential benefits and risks of bridging. In patients who had a first interruption of dabigatran or warfarin for an elective surgery/procedure, we compared the risk for major bleeding (MB), stroke or systemic embolism (SSE) and any thromboembolism (TE) in patients who were bridged or not bridged during the period of seven days before until 30 days after surgery/procedure. We used multivariable Cox regression to adjust for potential confounders. Bridging was used more during warfarin interruption than dabigatran interruption (27.5 % vs 15.4 %; p < 0.001). With dabigatran interruption, bridged patients had more MB (6.5 % vs 1.8 %, p < 0.001) than those not bridged but bridged and not bridged groups did not differ for any TE (1.2 % vs 0.6 %, p=0.16) and SSE (0.5 % vs 0.3 %, p=0.46). With warfarin interruption, bridged patients had more MB (6.8 % vs 1.6 %, p < 0.001) and any TE (1.8 % vs 0.3 %, p=0.007) than those not bridged but bridged and not bridged groups did not differ for SSE (0.5 % vs 0.2 %, p=0.321). In conclusion, in patients who interrupted dabigatran or warfarin for a surgery/ procedure in the RE-LY trial, use of bridging anticoagulation appeared to increase the risk for major bleeding irrespective of dabigatran or warfarin interruption.

Keywords

Bridging anticoagulation - surgery - dabigatran - warfarin

Full Text

References

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