Delate Thomas, Meisinger Stephanie M, Witt Daniel M, Jenkins Daniel, Douketis James D, Clark Nathan P
1 Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA.
2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Clin Appl Thromb Hemost. 2017 Nov;23(8):1036-1041. doi: 10.1177/1076029616669786. Epub 2016 Sep 21.
Bridge therapy is associated with an increased risk of major bleeding in patients with atrial fibrillation and venous thromboembolism (TE) without a corresponding reduction in TE. The benefits of bridge therapy in patients with mechanical heart valve (MHV) prostheses interrupting warfarin for invasive procedures are not well described.
A retrospective cohort study was conducted at an integrated health-care delivery system. Anticoagulated patients with MHV interrupting warfarin for invasive diagnostic or surgical procedures between January 1, 2006, and March 31, 2012, were identified. Patients were categorized according to exposure to bridge therapy during the periprocedural period and TE risk (low, medium, and high). Outcomes validated via manual chart review included clinically relevant bleeding, TE, and all-cause mortality in the 30 days following the procedure. There were 547 procedures in 355 patients meeting inclusion criteria. Mean cohort age was 65.2 years, and 38% were female. Bridge therapy was utilized in 466 (85.2%) procedures (95.2%, 77.3%, and 65.8% of high, medium, and low TE risk category procedures, respectively). The 30-day rate of clinically relevant bleeding was numerically higher in bridged (5.8%; 95% confidence interval [CI], 3.9%-8.3%) versus not bridged procedures (1.2%; 95% CI, <0.1%-6.7%; P = .102). No TEs or deaths were identified.
The use of bridge therapy is common among patients with MHV and may be associated with increased bleeding risk. Further research is needed to determine whether bridge therapy reduces TE in patients with MHV interrupting warfarin for invasive procedures.
桥接治疗与心房颤动和静脉血栓栓塞（TE）患者大出血风险增加相关，且未相应降低TE发生率。对于因侵入性操作而中断华法林治疗的机械心脏瓣膜（MHV）假体患者，桥接治疗的益处尚未得到充分描述。
在一个综合医疗服务系统中进行了一项回顾性队列研究。确定了2006年1月1日至2012年3月31日期间因侵入性诊断或外科手术而中断华法林治疗的抗凝MHV患者。根据围手术期桥接治疗暴露情况和TE风险（低、中、高）对患者进行分类。通过人工病历审查验证的结局包括术后30天内的临床相关出血、TE和全因死亡率。355例符合纳入标准的患者共进行了547例手术。队列平均年龄为65.2岁，38%为女性。466例（85.2%）手术采用了桥接治疗（高、中、低TE风险类别手术分别为95.2%、77.3%和65.8%）。桥接治疗组的30天临床相关出血发生率在数值上高于未桥接治疗组（5.8%；95%置信区间[CI]，3.9%-8.3%）与（1.2%；95%CI，<0.1%-6.7%；P = 0.102）。未发现TE或死亡病例。
桥接治疗在MHV患者中使用普遍，可能与出血风险增加有关。需要进一步研究以确定桥接治疗是否能降低因侵入性操作而中断华法林治疗的MHV患者的TE发生率。
