Periprocedural bridging in VTE patients tied to greater bleeding incidence
Compared with vitamin K antagonist (VKA) without bridging, periprocedural bridging is associated with a higher risk of bleeding, with no significant difference in periprocedural venous thromboembolism (VTE) rates, results of a systematic review have shown.
This study sought to examine recurrent VTE and bleeding outcomes with and without bridging in patients with previous VTE due to the uncertain benefits and risks of periprocedural bridging in this population.
The investigators searched the PubMed and Embase databases from inception to 7 December 2017 for randomized and nonrandomized studies that included adults with previous VTE requiring VKA interruption to undergo an elective procedure and that reported VTE or bleeding outcomes. Quality of evidence was graded by consensus.
Twenty-eight cohort studies (20 single-arm cohorts) with a total of 6,915 procedures were analysed. In 27 studies reporting perioperative VTE outcomes, recurrent VTE with bridging had a pooled incidence of 0.7 percent (95 percent CI, 0.4–1.2 percent), while that in recurrent VTE without bridging was 0.5 percent (0.3–0.8 percent).
In 18 studies, major or nonmajor bleeding outcomes were reported. The corresponding pooled incidence of any bleeding for with and without bridging was 3.9 percent (2.0–7.4 percent) and 0.4 percent (0.1–1.7 percent). The pooled incidence for VTE in bridged patients at high thromboembolic risk was 0.8 percent (0.3–2.5 percent) and 7.5 percent (3.1–17.4 percent) for any bleeding.
Due to a high risk of bias among included studies, the quality of available evidence was very low.
“VKA are the most widely used anticoagulants, and bridging is commonly administered during periprocedural VKA interruption,” the investigators said.