PMID- 16706967
OWN - NLM
STAT- MEDLINE
DCOM- 20071130
LR  - 20230829
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 4
IP  - 6
DP  - 2006 Jun
TI  - Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as 
      bridging therapy in patients on long-term oral anticoagulants: the REGIMEN 
      registry.
PG  - 1246-52
AB  - BACKGROUND: Patients who receive long-term oral anticoagulant (OAC) therapy often 
      require interruption of OAC for an elective surgical or an invasive procedure. 
      Heparin bridging therapy has been used in these situations, although the optimal 
      method has not been established. No large prospective studies have compared 
      unfractionated heparin (UFH) with low-molecular-weight heparin (LMWH) for the 
      perioperative management of patients at risk of thromboembolism requiring 
      temporary interruption of long-term OAC therapy. PATIENTS/METHODS: This 
      multicenter, observational, prospective registry conducted in North America 
      enrolled 901 eligible patients on long-term OAC who required heparin bridging 
      therapy for an elective surgical or invasive procedure. Practice patterns and 
      clinical outcomes were compared between patients who received either UFH alone (n 
      = 180) or LMWH alone (n = 721). RESULTS: Overall, the majority of patients 
      (74.5%) requiring heparin bridging therapy had arterial indications for OAC. 
      LMWH, in mostly twice-daily treatment doses, represented approximately 80% of the 
      study population. LMWH-bridged patients had significantly fewer arterial 
      indications for OAC, a lower mean Charlson comorbidity score, and were less 
      likely to undergo major or cardiothoracic surgery, receive intraprocedural 
      anticoagulants or thrombolytics, or receive general anesthesia than UFH-bridged 
      patients (all P < 0.05). The LMWH group had significantly more bridging therapy 
      completed in an outpatient setting or with a < 24-h hospital stay vs. the UFH 
      group (63.6% vs. 6.1%, P < 0.001). In the LMWH and UFH groups, similar rates of 
      overall adverse events (16.2% vs. 17.1%, respectively, P = 0.81), major composite 
      adverse events (arterial/venous thromboembolism, major bleed, and death; 4.2% vs. 
      7.9%, respectively, P = 0.07) and major bleeds (3.3% vs. 5.5%, respectively, P = 
      0.25) were observed. The thromboembolic event rates were 2.4% for UFH and 0.9% 
      for LMWH. Logistic regression analysis revealed that for postoperative heparin 
      use a Charlson comorbidity score > 1 was an independent predictor of a major 
      bleed and that vascular, general, and major surgery were associated with 
      non-significant trends towards an increased risk of major bleed. CONCLUSIONS: 
      Treatment-dose LMWH, mostly in the outpatient setting, is used substantially more 
      often than UFH as bridging therapy in patients with predominately arterial 
      indications for OAC. Overall adverse events, including thromboembolism and 
      bleeding, are similar for patients treated with LMWH or UFH. Postoperative 
      heparin bridging should be used with caution in patients with multiple 
      comorbidities and those undergoing vascular, general, and major surgery. These 
      findings need to be confirmed using large randomized trials for specific patient 
      groups undergoing specific procedures.
FAU - Spyropoulos, A C
AU  - Spyropoulos AC
AD  - Lovelace Medical Center, Albuquerque, NM 87108, USA. 
      alex.spyropoulos@lovelacesandia.com
FAU - Turpie, A G G
AU  - Turpie AG
FAU - Dunn, A S
AU  - Dunn AS
FAU - Spandorfer, J
AU  - Spandorfer J
FAU - Douketis, J
AU  - Douketis J
FAU - Jacobson, A
AU  - Jacobson A
FAU - Frost, F J
AU  - Frost FJ
CN  - REGIMEN Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Drug Administration Schedule
MH  - Elective Surgical Procedures
MH  - Female
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/*adverse effects
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Observation
MH  - Perioperative Care
MH  - Postoperative Hemorrhage/*chemically induced
MH  - Practice Patterns, Physicians'
MH  - Prospective Studies
MH  - Registries
MH  - Risk Factors
MH  - Thromboembolism/*chemically induced/prevention & control
MH  - Treatment Outcome
MH  - Warfarin/adverse effects/therapeutic use
EDAT- 2006/05/19 09:00
MHDA- 2007/12/06 09:00
CRDT- 2006/05/19 09:00
PHST- 2006/05/19 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2006/05/19 09:00 [entrez]
AID - S1538-7836(22)14087-0 [pii]
AID - 10.1111/j.1538-7836.2006.01908.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2006 Jun;4(6):1246-52. doi: 10.1111/j.1538-7836.2006.01908.x.