PMID- 31483512
OWN - NLM
STAT- MEDLINE
DCOM- 20200217
LR  - 20210110
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 42
IP  - 10
DP  - 2019 Oct
TI  - The effect of heparin infusion intensity on outcomes for bridging hospitalized 
      patients with atrial fibrillation.
PG  - 995-1002
LID - 10.1002/clc.23256 [doi]
AB  - BACKGROUND: Perioperative bridging in atrial fibrillation (AF) is associated with 
      low thromboembolic rates but high bleeding rates. Recent guidance cautions the 
      practice of bridging except in high risk patients. However, the practice of 
      bridging varies widely and little data exist regarding appropriate 
      anticoagulation intensity when using intravenous unfractionated heparin (UFH). 
      HYPOTHESIS: To determine if high intensity UFH infusion regimens are associated 
      with increased bleeding rates compared to low intensity regimens for bridging 
      patients with AF. METHODS: We conducted a single center retrospective cohort 
      study of admitted patients with non-valvular AF receiving UFH for >/=24 hours. UFH 
      intensities were chosen at the providers' discretion. The primary endpoint was 
      the rate of bleeding defined by the International Society on Thrombosis and 
      Hemostasis during UFH infusion or within 24 hours of discontinuation. The 
      secondary endpoint was a composite of cardiovascular events, arterial 
      thromboembolism, venous thromboembolism, myocardial infarctions and death during 
      UFH infusion. RESULTS: A total of 497 patients were included in this analysis. 
      Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of 
      patients. The rate of any bleed was higher among high intensity compared to low 
      intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval 
      = 1.07-4.90). Major bleeding was significantly higher among high intensity 
      compared to low intensity UFH regimens. There was no difference in composite 
      thrombotic events or death. CONCLUSIONS: Low intensity UFH infusions, targeting 
      lower anticoagulation targets, were associated with decreased bleeding rates 
      without a signal of increased thromboembolic events in hospitalized AF patients.
CI  - (c) 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
FAU - Warden, Bruce A
AU  - Warden BA
AUID- ORCID: 0000-0003-3635-7506
AD  - Department of Pharmacy Services, Oregon Health & Science University, Portland, 
      Oregon.
FAU - Diep, Calvin
AU  - Diep C
AD  - Department of Pharmacy, Stanford Medical Center, Stanford, California.
FAU - Ran, Ran
AU  - Ran R
AD  - Department of Critical Care Medicine, Oregon Health & Science University, 
      Portland, Oregon.
FAU - Thomas, Matthew
AU  - Thomas M
AD  - Department of Pharmacotherapy, Washington State University College of Pharmacy 
      and Pharmaceutical Sciences, Spokane, Washington.
FAU - Cigarroa, Joaquin E
AU  - Cigarroa JE
AD  - Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science 
      University, Portland, Oregon.
LA  - eng
PT  - Journal Article
DEP - 20190904
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - Atrial Fibrillation/blood/complications/*drug therapy
MH  - Blood Coagulation
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/epidemiology/prevention & control
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Incidence
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - United States/epidemiology
MH  - Venous Thromboembolism/blood/etiology/*prevention & control
PMC - PMC6788575
OTO - NOTNLM
OT  - anticoagulation
OT  - atrial fibrillation
OT  - bleeding
OT  - bridging
OT  - heparin
OT  - thrombosis
COIS- The authors declare no potential conflict of interests.
EDAT- 2019/09/05 06:00
MHDA- 2020/02/18 06:00
PMCR- 2019/09/04
CRDT- 2019/09/05 06:00
PHST- 2019/04/18 00:00 [received]
PHST- 2019/08/05 00:00 [revised]
PHST- 2019/08/26 00:00 [accepted]
PHST- 2019/09/05 06:00 [pubmed]
PHST- 2020/02/18 06:00 [medline]
PHST- 2019/09/05 06:00 [entrez]
PHST- 2019/09/04 00:00 [pmc-release]
AID - CLC23256 [pii]
AID - 10.1002/clc.23256 [doi]
PST - ppublish
SO  - Clin Cardiol. 2019 Oct;42(10):995-1002. doi: 10.1002/clc.23256. Epub 2019 Sep 4.