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Low molecular weight heparin bridging for atrial fibrillation: is VTE thromboprophylaxis the major benefit?

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Abstract

Paucity of data has led to a lack of consensus regarding indications for, and risk–benefit ratio of, low molecular weight heparin ‘bridging’ for cardioembolic prevention in patients with atrial fibrillation (AF) until their INR levels are in therapeutic range. Using a hospital database, we compared AF patients ≥65 years who were bridged (n = 265) with patients who were not bridged (n = 4532) after hospital discharge. Patients who failed to achieve a therapeutic INR within 30 days were excluded. CHADS2 scores (congestive heart failure, hypertension, age ≥75, diabetes, stroke), bleeding risk and co-morbidity scores were assessed. Unadjusted and adjusted odds ratios for outcome events (death, stroke, hemorrhage and venous thromboembolism (VTE) within 30 days of discharge were compared. Bridged patients, as compared to those not bridged, were younger (74.7 ± 6.6 vs. 78.5 ± 7.7 years), less likely to be white (36 vs. 51%), and less likely to have CHADS2 scores ≥2 (67 vs. 84%), all P < 0.001. There was no significant difference in bleeding risk (bridged vs. not bridged: 1.5 ± 7 vs. 1.7 ± 6). In logistic models adjusting for age, white race, bleeding risk, CHADS2 and Comorbidity scores, bridging was significantly associated with lower mortality and a decreased odds ratio for VTE (both P < 0.01) but not for stroke or hemorrhage (both P > 0.80). Although we found insufficient evidence of either lower stroke or greater bleeding risk with bridging, our data suggest the possibility that LMWH bridging in patients with AF is associated with lower risks of VTE and death within 30 days of discharge.

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Acknowledgments

This publication was made possible by the CTSA Grant UL1 RR025750, KL2 RR025749 and TL1 RR025748 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessary represent the official view of the NCRR or NIH. We also gratefully acknowledge Eran Bellin MD, PhD for the development and availability of Clinical Looking Glass.

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The authors report that they have nothing to disclose.

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Authors and Affiliations

  1. Division of Hematology, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Ave., Bronx, NY, 10467, USA

    Henny H. Billett, Barbara A. Scorziello & Emily R. Giannattasio

  2. Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467, USA

    Hillel W. Cohen

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  1. Henny H. Billett
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  2. Barbara A. Scorziello
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  3. Emily R. Giannattasio
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  4. Hillel W. Cohen
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Correspondence to Henny H. Billett.

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Billett, H.H., Scorziello, B.A., Giannattasio, E.R. et al. Low molecular weight heparin bridging for atrial fibrillation: is VTE thromboprophylaxis the major benefit?. J Thromb Thrombolysis 30, 479–485 (2010). https://doi.org/10.1007/s11239-010-0470-8

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  • DOI: https://doi.org/10.1007/s11239-010-0470-8

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