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Cerebrovascular Thromboembolic Events in Periprocedural Bridging Therapy vs Uninterrupted Anticoagulation in Long-Term Anticoagulant User with Atrial Fibrillation: A Mini Systematic Review

Author : Vidyawati, P. M. H Putri, T. Jatiman
Upload Date : 19-04-2018

Background The management of atrial fibrillation (AF) patients on oral anticoagulants (OAC) undergoing surgeries or invasive procedures is not well established. Interrupting OAC by bridging with short acting heparin is a common practice despite lacking evidences.

Objective We aim to compare cerebrovascular thromboembolic events (CTE) in bridging therapy (BT) with increasingly used uninterrupted anticoagulation (UAC) approach.

Method Structured literature search was conducted on databases such as PubMed, ScienceDirect, Wiley Online Library, and Cochrane comparing peri-procedural BT and UAC in AF patients with CTE endpoint. After screening of title and abstract, thirteen studies were retained for full-text examination. Only four studies fulfilled the inclusion criteria.

Results A total of 5884 patients were included in one prospective randomized trial and three observational studies. One randomized trial study in 2014 enrolled 294 patients, 2.0% CTE found in UAC and 14.1% in BT. In the same year, two observational studies (with total of 2227 and 2855 patients) also reported higher CTE in patients with UAC compared to BT (0.3% vs 0.6% and 0.4% vs 0.6%). All the three studies showed higher rate of CTE in BT, but one observational study in 2014 with a total of 508 patients reported slightly higher CTE among patients with UAC compared to BT (1.4% vs 0.8%). Of note, UAC had less CTE compared to BT.

Conclusion Among patients with AF on long term anticoagulants undergoing surgeries or invasive procedures, BT was associated with a higher rate of CTE compared to UAC. Several factors  related to total complications were bridging strategy, prior myocardial infarction, prior stroke, and left ventricular ejection fraction. It was suggested that patients who experience transitions in anticoagulants, at the same time are also experiencing a transition in care. However, further studies are needed to identify best practices concerning anticoagulation interruptions.

KEYWORDS : periprocedural, bridging therapy, anticoagulation, atrial fibrillation

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