VTE patients may not require periprocedural bridging therapy
MedWire News: Venous thromboembolism (VTE) patients who have their oral anticoagulation therapy interrupted before an invasive procedure are at low risk for recurrent thrombosis and bleeding, US researchers have found.
The team notes, however, that patients with an active malignancy are at greater risk for recurrent VTE, bleeding and death during interruption of treatment than other patients.
“Cancer patients require particular care given their propensity for both clotting and bleeding,” write Robert McBane II (Mayo Clinic, Rochester, Minnesota) and co-workers.
The researchers examined data for 775 patients who were referred for periprocedural anticoagulation management between 1997 and 2007, and were followed-up for 3 months.
The patients were classified by the time since their VTE episode, with 7% of patients requiring a procedure within 30 days of thrombosis (acute), 15% within 31–90 days (subacute), and the remainder after this time (chronic).
As reported in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, acute and subacute patients were significantly more likely to receive bridging therapy of low molecular weight heparin (LMWH) than chronic patients at 87% and 81% versus 59%, respectively.
Overall, recurrent VTE and major bleeding occurred in just 1.8% of patients, each, while 1.7% of patients died.
The risk for these outcomes was not significantly associated with receipt of LMWH bridging therapy, McBane II et al report.
However, patients with an active cancer were 4.86 times more likely to experience recurrent VTE, 6.8 times more likely to experience major bleeding, and 32.7 times more likely to die than patients without malignancy.
“Further studies are warranted to better-define best practices for cancer patients requiring anticoagulant interruption for an invasive procedure,” the researchers say.
They add: “For patients with remote history of VTE, it appears to be safe to simply hold warfarin for the periprocedure interval without pre-operative bridging heparin therapy.”
Nevertheless, they conclude: “A randomized, controlled trial is currently underway to better-define the utility of bridging therapy with LMWH in patients with atrial fibrillation. A similar trial enrolling patients with VTE is also warranted.”
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By Lynda Williams