Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.
Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.
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DOI：
10.1016/j.ahj.2017.09.015
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发表时间：
2018-01
影响因子：
4.8
通讯作者：
BRIDGE Investigators
中科院分区：
文献类型：
--
作者：
Clark NP;Douketis JD;Hasselblad V;Schulman S;Kindzelski AL;Ortel TL;BRIDGE Investigators
在因择期手术/程序而中断华法林期间使用低分子量肝素桥接治疗会增加出血。在这种情况下出血的其他预测因素没有得到很好的描述。BRIDGE是一项随机、双盲、安慰剂对照试验，在需要中断华法林的房颤患者中进行达肝素100 IU/kg每日两次的桥接治疗。记录从华法林中断至术后37天的出血结局。采用多元逻辑回归和时间依赖性风险模型来确定大出血的预测因子。我们分析了1,813例患者，其中895例接受桥接治疗，918例接受安慰剂治疗。患者中位年龄为72.6岁，73.3%为男性。术后中位时间为7.0天（四分位距：4.0-18.0天）时发生了41起大出血事件。桥接治疗是大出血（比值比[OR] = 2.4; 95%置信区间[CI]：1.2-4.8）、肾脏疾病史（OR=2.9; 95% CI：1.4-6.0）和高出血风险手术（vs.低出血风险手术）（OR=2.9; 95% CI：1.4-5.9）的基线预测因子。围手术期使用阿司匹林（OR=3.6; 95%CI：1.1-11.9）和术后INR >3.0（OR=2.1; 95%CI：1.5-3.1）是大出血的时间依赖性预测因子。与术后11-37天相比，大出血在前10天最常见（OR=3.5; 95% CI：1.8-6.9）。除桥接治疗外，围手术期阿司匹林使用、术后INR >3.0、肾衰竭病史和高出血风险手术增加了需要华法林中断的择期手术/手术时大出血的风险。https://clinicaltrials.gov/ct2/show/NCT00786474（NCT00786474）
The use of low-molecular-weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days post-procedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. We analyzed 1,813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6 years and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0 days (interquartile range: 4.0–18.0 days) post-procedure. 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). 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. 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). In addition to bridge therapy, perioperative aspirin use, post-procedure INR >3.0, a history of renal failure, and having a high bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption. https://clinicaltrials.gov/ct2/show/NCT00786474 (NCT00786474)
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影响因子：
4.8
作者：
Gage, BF;Yan, Y;Radford, MJ
通讯作者：
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