Clark NP, et al. - This study focused on the predictors of perioperative bleeding in patients who interrupt warfarin for an elective surgery or procedure. An increased risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption was reported in association with the following factors: perioperative aspirin use, post-procedure INR >3.0, a history of renal failure, and having a high bleeding risk procedure, bridge therapy.

Methods

• BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption.
• From the time of warfarin interruption until up to 37 days post-procedure, bleeding outcomes were documented.
• Major bleeding predictors were identified using multiple logistic regression and time-dependent hazard models.

Results

• Researchers analyzed 1813 patients of whom 895 received bridging and 918 received placebo.
• Data reported that the median patient age was 72.6 years and 73.3% were male.
• Findings also demonstrated that 41 major bleeding events occurred at a median time of 7.0 days (interquartile range: 4.0–18.0 days) post-procedure.
• It was also observed that bridge therapy was a baseline predictor of major bleeding (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.2–4.8), as was a history of renal disease (OR = 2.9; 95% CI: 1.4–6.0), and high bleeding risk procedures (vs. low bleeding risk procedures) (OR = 2.9; 95% CI: 1.4–5.9).
• As per observations, perioperative aspirin use (OR = 3.6; 95% CI: 1.1–11.9) and post-procedure INR >3.0 (OR = 2.1; 95%CI: 1.5–3.1) were time-dependent predictors of major bleeding.
• Additionally, data revealed that major bleeding was most common in the first 10 days compared to 11–37 days post-procedure (OR = 3.5; 95% CI: 1.8–6.9).