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Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).

Publication ,  Journal Article
Steinberg, BA; Peterson, ED; Kim, S; Thomas, L; Gersh, BJ; Fonarow, GC; Kowey, PR; Mahaffey, KW; Sherwood, MW; Chang, P; Piccini, JP ...
Published in: Circulation
February 3, 2015

BACKGROUND: Temporary interruption of oral anticoagulation for procedures is often required, and some propose using bridging anticoagulation. However, the use and outcomes of bridging during oral anticoagulation interruptions in clinical practice are unknown. METHODS AND RESULTS: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry is a prospective, observational registry study of US outpatients with atrial fibrillation. We recorded incident temporary interruptions of oral anticoagulation for a procedure, including the use and type of bridging therapy. Outcomes included multivariable-adjusted rates of myocardial infarction, stroke or systemic embolism, major bleeding, cause-specific hospitalization, and death within 30 days. Of 7372 patients treated with oral anticoagulation, 2803 overall interruption events occurred in 2200 patients (30%) at a median follow-up of 2 years. Bridging anticoagulants were used in 24% (n=665), predominantly low-molecular-weight heparin (73%, n=487) and unfractionated heparin (15%, n=97). Bridged patients were more likely to have had prior cerebrovascular events (22% versus 15%; P=0.0003) and mechanical valve replacements (9.6% versus 2.4%; P<0.0001); however, there was no difference in CHA2DS2-VASc scores (scores ≥ 2 in 94% versus 95%; P=0.5). Bleeding events were more common in bridged than nonbridged patients (5.0% versus 1.3%; adjusted odds ratio, 3.84; P<0.0001). The incidence of myocardial infarction, stroke or systemic embolism, major bleeding, hospitalization, or death within 30 days was also significantly higher in patients receiving bridging (13% versus 6.3%; adjusted odds ratio, 1.94; P=0.0001). CONCLUSIONS: Bridging anticoagulation is used in one quarter of anticoagulation interruptions and is associated with higher risk for bleeding and adverse events. These data do not support the use of routine bridging, and additional data are needed to identify best practices concerning anticoagulation interruptions. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 3, 2015

Volume

131

Issue

5

Start / End Page

488 / 494

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Registries
  • Prospective Studies
  • Male
  • Humans
  • Hemorrhage
  • Follow-Up Studies
  • Female
  • Drug Administration Schedule
  • Cohort Studies
 

Citation

APA
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Steinberg, B. A., Peterson, E. D., Kim, S., Thomas, L., Gersh, B. J., Fonarow, G. C., … Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Investigators and Patients. (2015). Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation, 131(5), 488–494. https://doi.org/10.1161/CIRCULATIONAHA.114.011777
Steinberg, Benjamin A., Eric D. Peterson, Sunghee Kim, Laine Thomas, Bernard J. Gersh, Gregg C. Fonarow, Peter R. Kowey, et al. “Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).Circulation 131, no. 5 (February 3, 2015): 488–94. https://doi.org/10.1161/CIRCULATIONAHA.114.011777.
Steinberg BA, Peterson ED, Kim S, Thomas L, Gersh BJ, Fonarow GC, Kowey PR, Mahaffey KW, Sherwood MW, Chang P, Piccini JP, Ansell J, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Investigators and Patients. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation. 2015 Feb 3;131(5):488–494.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 3, 2015

Volume

131

Issue

5

Start / End Page

488 / 494

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Registries
  • Prospective Studies
  • Male
  • Humans
  • Hemorrhage
  • Follow-Up Studies
  • Female
  • Drug Administration Schedule
  • Cohort Studies