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Steven Almany, M.D. (In Memoriam)
Article
Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery.
The American Journal of Medicine (2019)
  • Geoffrey D Barnes, Frankel Cardiovascular Center
  • Yun Li, University of Michigan
  • Xiaokui Gu, Frankel Cardiovascular Center
  • Brian Haymart, Frankel Cardiovascular Center
  • Eva Kline-Rogers, Frankel Cardiovascular Center
  • Steven Almany, Beaumont Health
  • Jay Kozlowski, Huron Valley Sinai Hospital, Commerce Township, Mich
  • Gregory D Krol, Henry Ford Health System
  • Michael McNamara, Spectrum Health
  • James B Froehlich, Frankel Cardiovascular Center
  • Scott Kaatz, Henry Ford Health System
Link
Abstract
Use of bridging anticoagulation has been shown to be harmful and without benefit in warfarin-treated patients with atrial fibrillation. We performed a quasi-experimental interrupted time series analysis between 2010 and 2017 in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) collaborative before and after the BRIDGE trial publication (July 2015). Predicted use of bridging at the end of the study period was calculated with and without the effect of the BRIDGE trial after adjustment for patient-level clustering. Predictors of bridging anticoagulation use in the post-BRIDGE trial period were analyzed. In adjusted analyses, the use of bridging anticoagulation declined from a predicted 27.8% (95% confidence interval, 20.5%-35.1%) to 13.6% (95% confidence interval, 9.0%-18.2%) at the end of 2017 (P = .001) in response to the BRIDGE trial. Use of bridging anticoagulation declined similarly among atrial fibrillation patients at low risk for stroke (29.0% to 14.4%) and intermediate or high risk for stroke (38.0%-20.3%). Younger age and a prior history of stroke were independent predictors of bridging anticoagulation use following the BRIDGE trial publication. The BRIDGE trial publication is associated with a rapid and significant decline in the use of periprocedural bridging anticoagulation.
Keywords
  • Anticoagulation,
  • Evidence-based practice,
  • Heparin,
  • Low molecular weight,
  • Perioperative,
  • Warfarin.
Disciplines
Publication Date
January 1, 2019
DOI
10.1016/J.AMJMED.2018.07.027
Citation Information
Barnes GD, Li Y, Gu X, Haymart B, Kline-Rogers E, Almany S, Kozlowski J, Krol G, McNamara M, Froehlich JB, Kaatz S. Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery. Am J Med. 2019 Jan;132(1):109.e1-109.e7. doi: 10.1016/j.amjmed.2018.07.027. Epub 2018 Aug 1. PMID: 30076828.