%0 Journal Article %1 Douketis2015 %A Douketis, James D. %A Spyropoulos, Alex C. %A Kaatz, Scott %A Becker, Richard C. %A Caprini, Joseph A. %A Dunn, Andrew S. %A Garcia, David A. %A Jacobson, Alan %A Jaffer, Amir K. %A Kong, David F. %A Schulman, Sam %A Turpie, Alexander G.G. %A Hasselblad, Vic %A Ortel, Thomas L. %D 2015 %J New England Journal of Medicine %K Adult Anticoagulants Anticoagulants:administration&dosage Anticoagulants:adverseeffects AtrialFibrillation AtrialFibrillation:drugtherapy Double-BlindMethod ElectiveSurgicalProcedures Female Hemorrhage Hemorrhage:chemicallyinduced Heparin Humans Low-Molecular-Weight Low-Molecular-Weight:administration&do Low-Molecular-Weight:adverseeffects Male PerioperativePeriod PostoperativeComplications PostoperativeComplications:prevention&control Thromboembolism Thromboembolism:prevention&control Warfarin Warfarin:administration&dosage Warfarin:adverseeffects %N 9 %P 150622051516008 %R 10.1056/NEJMoa1501035 %T Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation %U http://www.ncbi.nlm.nih.gov/pubmed/26095867 %V 373 %X Background It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. Methods We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. Results In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval CI, -0.6 to 0.8; P=0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P=0.005 for superiority). Conclusions In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474 .).

@article{Douketis2015, abstract = {Background It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. Methods We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. Results In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], -0.6 to 0.8; P=0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P=0.005 for superiority). Conclusions In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474 .).}, added-at = {2023-02-03T11:44:35.000+0100}, author = {Douketis, James D. and Spyropoulos, Alex C. and Kaatz, Scott and Becker, Richard C. and Caprini, Joseph A. and Dunn, Andrew S. and Garcia, David A. and Jacobson, Alan and Jaffer, Amir K. and Kong, David F. and Schulman, Sam and Turpie, Alexander G.G. and Hasselblad, Vic and Ortel, Thomas L.}, biburl = {https://www.bibsonomy.org/bibtex/2311f2f8009c59be7b57af8a309489d44/jepcastel}, doi = {10.1056/NEJMoa1501035}, interhash = {0a8bad60268f68bbbbbbf6c15eab1de3}, intrahash = {311f2f8009c59be7b57af8a309489d44}, issn = {0028-4793}, journal = {New England Journal of Medicine}, keywords = {Adult Anticoagulants Anticoagulants:administration&dosage Anticoagulants:adverseeffects AtrialFibrillation AtrialFibrillation:drugtherapy Double-BlindMethod ElectiveSurgicalProcedures Female Hemorrhage Hemorrhage:chemicallyinduced Heparin Humans Low-Molecular-Weight Low-Molecular-Weight:administration&do Low-Molecular-Weight:adverseeffects Male PerioperativePeriod PostoperativeComplications PostoperativeComplications:prevention&control Thromboembolism Thromboembolism:prevention&control Warfarin Warfarin:administration&dosage Warfarin:adverseeffects}, month = {6}, note = {Tests d'equivalència; Exemple; CV<br/><br/>Veure nota addicional sobre el risc acceptable segons la incidència}, number = 9, pages = 150622051516008, pmid = {26095867}, timestamp = {2023-02-03T11:44:35.000+0100}, title = {Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26095867}, volume = 373, year = 2015 }