Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery - 19/12/18
, Yun Li, PhD b, Xiaokui Gu, MD, MA a, Brian Haymart, RN, MS a, Eva Kline-Rogers, NP a, Steven Almany, MD c, Jay Kozlowski, MD d, Gregory Krol, MD e, Michael McNamara, MD f, James B. Froehlich, MD, MPH a, Scott Kaatz, DO, MSc eAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Anticoagulation, Evidence-based practice, Heparin, Low molecular weight, Perioperative, Warfarin
Plan
| Funding: Blue Cross Blue Shield of Michigan and National Institutes of Health/National Heart, Lung, and Blood Institute (K01HL135392 to GDB). The funding organizations had no role in the design and conduct of the study; data collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. |
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| Conflict of Interest: GDB: Consulting for Pfizer/Bristol Myers Squibb and Janssen. Grant support from Pfizer/Bristol Myers Squib, Blue Cross/Blue Shield of Michigan, and the National Heart Lung and Blood Institute. EKR: Consulting for Janssen and the American College of Physicians; Board of directors for AC Forum. SA: Consulting for Kona, Trice Orthopedics, and Micardia; grant support from Boston Scientific Watchman and the Abbott Absorb Trial; ownership in Biostar Ventures and Ablative Solutions; JBF: Consulting for Merck, Janssen, Novartis; grant support from Blue Cross/Blue Shield of Michigan, Fibromuscular Disease Society of America; he serves on the Advisory Committee of Boehringer-Ingelheim and Pfizer. SK: Consultant for Boehringer Ingelheim, Bristol Myer Squibb/Pfizer, Janssen, Daiichi Sankyo, Portola, and Roche. The other authors have no disclosures to report. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 132 - N° 1
P. 109.e1-109.e7 - janvier 2019 Retour au numéro
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