Abstract Number: OC 46.1
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Bridging with low molecular weight heparin for periprocedural management of patients on direct oral anticoagulants undergoing invasive procedures is not supported by scientific evidence, and reports from real world practice addressing this topic are scant.
Aims: To describe and analyze periprocedural heparin use and clinical events in unselected, edoxaban-treated patients undergoing invasive procedures in routine clinical practice.
Methods: The prospective EMIT-AF/VTE study collected data on periprocedural management and clinical events in patients from Europe and Asia treated with edoxaban and undergoing diagnostic/therapeutic procedures, from 5 days pre- to 30 days post-procedure. Bridging was defined as heparin use during periprocedural period in lieu of edoxaban. The primary clinical event outcome was ISTH major bleeding (MB). Secondary outcomes included clinically relevant non-major bleeding (CRNMB) and acute thromboembolic events.
Results: In 1,619 patients, 2,155 procedures were performed, 94% in AF and 6% in VTE patients. Heparin bridging was used in 194 (9%) procedures. Patients with heparin bridging had higher CHA2DS2-VASc (3.6 ± 1.5 vs 3.2 ± 1.6) and HAS-BLED scores (2.4 ± 1.0 vs 1.8 ± 1.1) than those without bridging. Bridging was approximately 5 times more frequent in EHRA high bleeding risk procedures (24%; 120/502) than in low risk (5%; 48/998) and minor risk procedures (5%; 24/501) (Table 1). MB/CRNMB were more frequent in procedures with heparin bridging (3.6%; 7/194) than in those without bridging (0.9%; 17/1961). Ischemic stroke occurred in 0.5% (1/194) of procedures with heparin bridging and in 0.4% (7/1961) of procedures without bridging (Table 2).
| Baseline characteristics | Procedures without heparin bridging (n=1961) |
Procedures with heparin bridging (n=194) |
| Age [years], Mean (SD) | 71.8 (9.8) | 72.2 (11.0) |
| Male, n (%) | 1304 (66.5) | 119 (61.3) |
| Weight [kg], Mean (SD) | 77.8 (17.1) | 80.8 (17.0) |
| Body Mass Index [kg/m2], Mean (SD) | 27.3 (4.8) | 27.7 (4.7) |
| Creatinine Clearance [mL/min], Mean (SD) | 72.3 (30.4) | 77.2 (33.2) |
| EHRA Bleeding Risk of Procedure, n (%) | ||
| High | 382 (19.5) | 120 (61.9) |
| Low | 950 (48.4) | 48 (24.7) |
| Minor | 477 (24.3) | 24 (12.4) |
Baseline characteristics by heparin bridgingEHRA = European Heart Rhythm Association
| Clinical events | Procedures without heparin bridging (n=1961) |
Procedures with heparin bridging (n=194) |
p-value |
| All Bleeding | 55 (2.8%) | 13 (6.7%) | 0.003 |
| MB or CRNMB | 17 (0.9%) | 7 (3.6%) | 0.001 |
| Acute coronary syndrome | 0 | 1 (0.5%) | 0.09 |
| Ischemic Stroke | 7 (0.4%) | 1 (0.5%) | 0.53 |
| Transient ischemic attack | 2 (0.1%) | 0 | 1.00 |
| Systemic embolic events | 0 | 1 (0.5%) | 0.09 |
| Cardiovascular mortality | 4 (0.2%) | 1 (0.5%) | 0.38 |
| All-cause mortality | 12 (0.6%) | 2 (1.0%) | 0.36 |
Clinical events by heparin bridging
Conclusions: Heparin bridging was uncommon in unselected patients treated with edoxaban and undergoing invasive procedures in routine clinical practice. Bridging was more frequent in EHRA high bleeding risk procedures, was associated with more MB/CRNMB, but did not influence the incidence of acute thromboembolic events.
To cite this abstract in AMA style:
Santamaria A, Chen C, Von Heymann C, Vanassche T, Saxena M, Jin J, Unverdorben M, Colonna P. Peri-procedural Heparin Use in Patients Receiving Edoxaban: Analyses of the Noninterventional Global EMIT (Edoxaban Management in Diagnostic and Therapeutic Procedures) Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/peri-procedural-heparin-use-in-patients-receiving-edoxaban-analyses-of-the-noninterventional-global-emit-edoxaban-management-in-diagnostic-and-therapeutic-procedures-study/. Accessed September 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/peri-procedural-heparin-use-in-patients-receiving-edoxaban-analyses-of-the-noninterventional-global-emit-edoxaban-management-in-diagnostic-and-therapeutic-procedures-study/