NIH study on atrial fibrillation published in New England Journal of Medicine

Alex C. Spyropoulos, M.D., system medical director of the Anticoagulation and Clinical Thrombosis Services at the North Shore-LIJ Health System is part of the steering committee that will discuss results of the BRIDGE study, a randomized trial on atrial fibrillation June 22 at The International Society on Thrombosis and Haemostasis (ISTH) 2015 Congress. The findings are published simultaneously in the June issue of New England Journal of Medicine.

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. Symptoms often include heart palpitations, shortness of breath and weakness. It is a serious medical condition that sometimes requires emergency treatment and may lead to blood clots forming in the heart, which can circulate to other organs especially the brain and lead to blocked blood flow, causing strokes and other blood clots.

The BRIDGE trial, sponsored by the National Institutes of Health, was designed to determine whether bridging anticoagulation is needed in patients with atrial fibrillation who are receiving warfarin and need temporary interruption in order to undergo an elective surgery or procedure.

It found that in patients with atrial fibrillation who interrupt warfarin for an elective operation or procedure, forgoing bridging anticoagulation was non-inferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. Bridging anticoagulation refers to giving atrial fibrillation patients a short-acting blood thinner, usually by injecting low-molecular-weight heparin for 10 to 12 days around the time of the surgery or procedure when warfarin is interrupted and its anticoagulant effect is outside its therapeutic range. Bridging therapy is quite common and thought to be used by more than half a million patients in the U.S. annually on warfarin in periprocedural situations. Physicians were uncertain if bridging anticoagulation actually reduced a patients' risk for developing stroke and other blood clots or if it is was not helpful and might cause harm by increasing the risk for bleeding complications.

Based on the BRIDGE trial findings, Spyropoulos said, 'We now have strong scientific evidence to show that in patients with atrial fibrillation who need temporary interruption of warfarin for an elective procedure or surgery, forgoing bridging altogether is a less costly, and more convenient option in medical practice and leads to a reduction of adverse events around the time of procedure. In fact, results show that forgoing bridging reduces the risk of periprocedural major bleeding by almost 60 percent, without any increase in stroke risk.'

Patients who suffer from atrial fibrillation receive long-term treatment with the blood thinner warfarin. These patients frequently require warfarin to be stopped because of an upcoming surgery or procedure. It was commonly believed that bridging anticoagulation before and after the surgery or procedure might decrease the risk of periprocedural stroke and systemic embolism for the patient.

Spyropoulos is part of the Steering Committee that will present this data during and oral presentation on Monday, June 22 at The International Society on Thrombosis and Haemostasis (ISTH) 2015 Congress.

More information:
medicalxpress.com/news/2015-06 … inners-elective.html

Provided by North Shore-Long Island Jewish Health System