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Nation-Wide Use of Periprocedural Bridging Anticoagulation in Patients With Atrial Fibrillation

  • Geoffrey D. Barnes
    Correspondence
    Corresponding author: Tel: (734) 763-0047.
    Affiliations
    Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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  • Kristian Seiler
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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  • Patrick Brady
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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  • Neil Kamdar
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

    Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan

    Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan

    Department of Surgery, University of Michigan, Ann Arbor, Michigan

    Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
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      The randomized, controlled BRIDGE trial established a lack of efficacy for use of bridging anticoagulation in warfarin-treated patients who underwent surgical procedures. A large nation-wide insurance claims database was used to perform a retrospective interrupted time series cohort study of adult patients with atrial fibrillation treated with warfarin who underwent surgical procedures. Patients were assessed for the use of low-molecular-weight heparin (LMWH) use as a periprocedural bridging anticoagulant between July 2015 and November 2017. The interrupted time series regression model was used to estimate the reduction in use of bridging LMWH following the publication of the BRIDGE trial in July 2015. The cohort consisted of 9,278 warfarin-treated patients with atrial fibrillation. Use of bridging LMWH declined by an estimated 6.7% (95% confidence interval [CI] 2.1% to 11.3%) to 13.0% following publication of the BRIDGE trial. The decline in bridging LMWH use was numerically larger for patients with a moderate- or high risk of stroke (8.9% decline, 95% CI 0.4% to 17.4%) than for patients at low risk for stroke (6.2% decline, 95% CI 0.7% to 11.5%). Significant predictors of bridging LMWH use include younger age and no co-morbid diabetes. In conclusion, this nation-wide, claims-based study identified a significant reduction in the use of bridging LMWH following the publication of the BRIDGE trial for warfarin-treated patients with AF.
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