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Starting anticoagulation with vitamin k antagonists alone or with concomitant low-molecular weight heparin for non-valvular atrial fibrillation

Published:September 28, 2018DOI:https://doi.org/10.1016/j.ejim.2018.09.016
      It is well known that a majority of patients with non-valvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKA) do not benefit from bridging anticoagulation for ambulatory procedures [
      • Douketis J.D.
      • Spyropoulos A.C.
      • Kaatz S.
      • et al.
      Perioperative bridging anticoagulation in patients with atrial fibrillation.
      ,
      • Doherty J.U.
      • Gluckman T.J.
      • Hucker W.J.
      • et al.
      2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: A report of the American college of cardiology clinical expert consensus document task force.
      ,
      • Vivas D.
      • Roldán I.
      • Ferrandis R.
      • et al.
      Perioperative and periprocedural management of antithrombotic therapy: Consensus document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.
      ]. Conversely, there is little evidence around overlapping low-molecular weight heparin (LMWH) with VKA when starting anticoagulation, despite it being common practice. The present study aimed to describe the frequency of use of an overlapping strategy and determine the incidence of bleeding and thrombotic events based on whether this strategy or VKA were used.

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      References

        • Douketis J.D.
        • Spyropoulos A.C.
        • Kaatz S.
        • et al.
        Perioperative bridging anticoagulation in patients with atrial fibrillation.
        N Engl J Med. 2015; 373: 823-833
        • Doherty J.U.
        • Gluckman T.J.
        • Hucker W.J.
        • et al.
        2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: A report of the American college of cardiology clinical expert consensus document task force.
        J Am Coll Cardiol. 2017; 69: 871-898
        • Vivas D.
        • Roldán I.
        • Ferrandis R.
        • et al.
        Perioperative and periprocedural management of antithrombotic therapy: Consensus document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.
        Rev Esp Cardiol. 2018; 71: 553-564
        • Schulman S.
        • Kearon C.
        Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.
        J Thromb Haemost. 2005; 3: 692-694
        • Spyropoulos A.C.
        • Douketis J.D.
        • Gerotziafas G.
        • et al.
        Periprocedural antithrombotic and bridging therapy: recommendations for standardized reporting in patients with arterial indications for chronic oral anticoagulant therapy.
        J Thromb Haemost. 2012; 10: 692-694
        • Bouillon K.
        • Bertrand M.
        • Boudali L.
        • Ducimetière P.
        • Dray-Spira R.
        • Zureik M.
        Short-term risk of bleeding during heparin bridging at initiation of vitamin k antagonist therapy in more than 90 000 patients with nonvalvular atrial fibrillation managed in outpatient care.
        J Am Heart Assoc. 2016; 5e004065
        • Rechenmacher S.J.
        • Fang J.C.
        Bridging anticoagulation.
        J Am Coll Cardiol. 2015; 66: 1392-1403
        • Slivnick J.A.
        • Yeow R.Y.
        • McMahon C.
        • Paje D.G.
        • Kurlander J.E.
        • Barnes G.D.
        Current trends in anticoagulation bridging for patients with chronic atrial fibrillation on warfarin undergoing endoscopy.
        Am J Cardiol. 2018; 121: 1548-1551
        • Steinberg B.A.
        • Peterson E.D.
        • Kim S.
        • et al.
        Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: Findings from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF).
        Circulation. 2015; 131: 488-494