PMID- 22534746
OWN - NLM
STAT- MEDLINE
DCOM- 20121112
LR  - 20121115
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 108
IP  - 1
DP  - 2012 Jul
TI  - The HAS-BLED score predicts bleedings during bridging of chronic oral 
      anticoagulation. Results from the national multicentre BNK Online bRiDging 
      REgistRy (BORDER).
PG  - 65-73
LID - 10.1160/TH11-12-0827 [doi]
AB  - Patients who receive long-term oral anticoagulant (OAC) therapy often require 
      interruption of OAC for an elective invasive procedure. Current guidelines allow 
      bridging therapy with either unfractionated heparin (UFH) or low-molecular-weight 
      heparin (LMWH). Apart from the risk of embolism, bleeding is an important 
      complication in this setting and the optimal perioperative management of such 
      patients is still under discussion. The aims of this prospective, observational, 
      multicentre registry of patients treated by cardiologists were: 1) to evaluate 
      current practice of perioperative management of OAC in a large outpatient cohort, 
      2) to document embolic and haemorrhagic events, and 3) to identify risk factors 
      predicting adverse events. In the years 2009 and 2010, 1,000 invasive procedures 
      (cardiac catheterisation n=533, pacemaker implantation n = 128, surgery n = 194, 
      other n = 145) were performed in patients with OAC. Sixty- one (6.1%) of those 
      patients did not receive bridging therapy during interruption of OAC, 937 (93.7%) 
      patients were treated with LMWH, two patients (0.2%) received UFH. In 22 patients 
      (2.2%) LMWHs were given in prophylactic dose, 727 patients (72.7%) were treated 
      with halved therapeutic (i.e. weight-adapted) LMWH doses and 188 (18.8%) received 
      full therapeutic LMWH doses. Four thromboembolic complications were observed 
      during 30 days of follow-up (two retinal embolisms, one stroke, one myocardial 
      infarction; 0.4%). One major bleeding (0.1%) and 35 clinically relevant bleedings 
      (3.5%) occurred. Rehospitalisation after bleedings was necessary in 20 patients. 
      Independent predictors for bleedings were history of mechanical heart valve 
      replacement (MVR) (p=0.0002) and the HAS-BLED score (<0.0001), with a cut off 
      value >/= 3 being the most predictive variable for haemorrhage (hazard ratio 11.8, 
      95% confidence interval 5.6-24.9, p<0.0001). A total of 527 patients with atrial 
      fibrillation and a CHADS(2) score </= 2 received halved therapeutic or full 
      therapeutic dosages of LMWH despite a low embolic risk, whereas 49 of the 
      patients with heart valve replacement (51%) did not receive dosages of bridging 
      therapy as recommended in guidelines. In conclusion, in this registry of patients 
      treated by cardiologists, 94% of patients who required interruption of OAC before 
      invasive procedures received LMWH as a bridging therapy, of whom 73% were treated 
      with halved therapeutic LMWH-dosages. Guideline recommendations were followed in 
      only 31% of cases. Importantly, 69% of patients with AF were over-treated while 
      51% of patients with heart valve replacement were under-treated with LMWHs. A 
      HASB-BLED score >/= 3 was highly predictive of bleeding events.
FAU - Omran, Heyder
AU  - Omran H
AD  - St. Marien Hospital Bonn Venusberg, Department of Internal Medicine, Bonn, 
      Germany.
FAU - Bauersachs, Rupert
AU  - Bauersachs R
FAU - Rubenacker, Siegfried
AU  - Rubenacker S
FAU - Goss, Franz
AU  - Goss F
FAU - Hammerstingl, Christoph
AU  - Hammerstingl C
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20120426
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Thromb Haemost. 2012 Jul;108(1):9-10. PMID: 22688666
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - *Cardiac Catheterization
MH  - Female
MH  - Heart Diseases/*surgery
MH  - Hemorrhage/chemically induced/*diagnosis/prevention & control
MH  - Heparin/*administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse effects
MH  - Humans
MH  - Intraoperative Care
MH  - Intraoperative Complications/chemically induced/*diagnosis/prevention & control
MH  - Male
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Prospective Studies
MH  - *Prosthesis Implantation
MH  - Registries
MH  - Risk Factors
EDAT- 2012/04/27 06:00
MHDA- 2012/11/13 06:00
CRDT- 2012/04/27 06:00
PHST- 2011/12/05 00:00 [received]
PHST- 2012/04/12 00:00 [accepted]
PHST- 2012/04/27 06:00 [entrez]
PHST- 2012/04/27 06:00 [pubmed]
PHST- 2012/11/13 06:00 [medline]
AID - 11-12-0827 [pii]
AID - 10.1160/TH11-12-0827 [doi]
PST - ppublish
SO  - Thromb Haemost. 2012 Jul;108(1):65-73. doi: 10.1160/TH11-12-0827. Epub 2012 Apr 
      26.