Periprocedural anticoagulation management of patients with venous thromboembolism

Robert D. McBane, Waldemar E. Wysokinski, Paul R. Daniels, Scott C. Litin, Joshua Slusser, David O. Hodge, Nicole F. Dowling, John A. Heit

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Objective-Patients with venous thromboembolism (VTE) often require temporary warfarin interruption for an invasive procedure. The incidence of thromboembolism and bleeding related to periprocedural anticoagulation management of such patients is unknown. Methods and Results-In a protocol-driven, inception cohort design study, all VTE patients (n=775) referred for periprocedural anticoagulation management (1997-2007) were followed-up to estimate the 3-month cumulative incidence of thromboembolism and bleeding. Patients were stratified by thrombus acuity (acute, <30 days; subacute, 31-90 days; or chronic ≥91 days). Decisions to provide "bridging" low-molecular-weight heparin were based on estimated thromboembolism and bleeding risk. Low-molecular-weight heparin was more often administered in acute (87%) and subacute (81%) VTE compared to chronic VTE (59%; P<0.001). The 3-month cumulative incidence of thromboembolism (1.8%), major hemorrhage (1.8%), and mortality (1.7%) were low and did not differ by management strategy. Active cancer was the only independent predictor of thrombotic recurrence (HR, 4.86; 95% CI, 1.6-14.5; P=0.005), major hemorrhage (HR, 6.8; 95% CI, 2.1-21.7; P=0.001), and death (HR, 32.7; 95% CI, 4.3-251.2; P=0.0008). Conclusion-Thromboembolism, bleeding, and death among VTE patients in whom anticoagulation is temporarily interrupted for an invasive procedure is low. Cancer patients require particular care given their propensity for both clotting and bleeding.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Volume30
Issue number3
DOIs
StatePublished - Mar 2010

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Venous Thromboembolism
Thromboembolism
Hemorrhage
Low Molecular Weight Heparin
Incidence
Warfarin
Neoplasms
Thrombosis
Cohort Studies
Recurrence
Mortality

Keywords

  • Anticoagulation
  • Deep vein thrombosis
  • Pulmonary embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

McBane, R. D., Wysokinski, W. E., Daniels, P. R., Litin, S. C., Slusser, J., Hodge, D. O., ... Heit, J. A. (2010). Periprocedural anticoagulation management of patients with venous thromboembolism. Arteriosclerosis, Thrombosis, and Vascular Biology, 30(3), 442-448. https://doi.org/10.1161/ATVBAHA.109.199406

Periprocedural anticoagulation management of patients with venous thromboembolism. / McBane, Robert D.; Wysokinski, Waldemar E.; Daniels, Paul R.; Litin, Scott C.; Slusser, Joshua; Hodge, David O.; Dowling, Nicole F.; Heit, John A.

In: Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 30, No. 3, 03.2010, p. 442-448.

Research output: Contribution to journalArticle

McBane, RD, Wysokinski, WE, Daniels, PR, Litin, SC, Slusser, J, Hodge, DO, Dowling, NF & Heit, JA 2010, 'Periprocedural anticoagulation management of patients with venous thromboembolism', Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 30, no. 3, pp. 442-448. https://doi.org/10.1161/ATVBAHA.109.199406
McBane, Robert D. ; Wysokinski, Waldemar E. ; Daniels, Paul R. ; Litin, Scott C. ; Slusser, Joshua ; Hodge, David O. ; Dowling, Nicole F. ; Heit, John A. / Periprocedural anticoagulation management of patients with venous thromboembolism. In: Arteriosclerosis, Thrombosis, and Vascular Biology. 2010 ; Vol. 30, No. 3. pp. 442-448.
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abstract = "Objective-Patients with venous thromboembolism (VTE) often require temporary warfarin interruption for an invasive procedure. The incidence of thromboembolism and bleeding related to periprocedural anticoagulation management of such patients is unknown. Methods and Results-In a protocol-driven, inception cohort design study, all VTE patients (n=775) referred for periprocedural anticoagulation management (1997-2007) were followed-up to estimate the 3-month cumulative incidence of thromboembolism and bleeding. Patients were stratified by thrombus acuity (acute, <30 days; subacute, 31-90 days; or chronic ≥91 days). Decisions to provide {"}bridging{"} low-molecular-weight heparin were based on estimated thromboembolism and bleeding risk. Low-molecular-weight heparin was more often administered in acute (87{\%}) and subacute (81{\%}) VTE compared to chronic VTE (59{\%}; P<0.001). The 3-month cumulative incidence of thromboembolism (1.8{\%}), major hemorrhage (1.8{\%}), and mortality (1.7{\%}) were low and did not differ by management strategy. Active cancer was the only independent predictor of thrombotic recurrence (HR, 4.86; 95{\%} CI, 1.6-14.5; P=0.005), major hemorrhage (HR, 6.8; 95{\%} CI, 2.1-21.7; P=0.001), and death (HR, 32.7; 95{\%} CI, 4.3-251.2; P=0.0008). Conclusion-Thromboembolism, bleeding, and death among VTE patients in whom anticoagulation is temporarily interrupted for an invasive procedure is low. Cancer patients require particular care given their propensity for both clotting and bleeding.",
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AU - McBane, Robert D.

AU - Wysokinski, Waldemar E.

AU - Daniels, Paul R.

AU - Litin, Scott C.

AU - Slusser, Joshua

AU - Hodge, David O.

AU - Dowling, Nicole F.

AU - Heit, John A.

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N2 - Objective-Patients with venous thromboembolism (VTE) often require temporary warfarin interruption for an invasive procedure. The incidence of thromboembolism and bleeding related to periprocedural anticoagulation management of such patients is unknown. Methods and Results-In a protocol-driven, inception cohort design study, all VTE patients (n=775) referred for periprocedural anticoagulation management (1997-2007) were followed-up to estimate the 3-month cumulative incidence of thromboembolism and bleeding. Patients were stratified by thrombus acuity (acute, <30 days; subacute, 31-90 days; or chronic ≥91 days). Decisions to provide "bridging" low-molecular-weight heparin were based on estimated thromboembolism and bleeding risk. Low-molecular-weight heparin was more often administered in acute (87%) and subacute (81%) VTE compared to chronic VTE (59%; P<0.001). The 3-month cumulative incidence of thromboembolism (1.8%), major hemorrhage (1.8%), and mortality (1.7%) were low and did not differ by management strategy. Active cancer was the only independent predictor of thrombotic recurrence (HR, 4.86; 95% CI, 1.6-14.5; P=0.005), major hemorrhage (HR, 6.8; 95% CI, 2.1-21.7; P=0.001), and death (HR, 32.7; 95% CI, 4.3-251.2; P=0.0008). Conclusion-Thromboembolism, bleeding, and death among VTE patients in whom anticoagulation is temporarily interrupted for an invasive procedure is low. Cancer patients require particular care given their propensity for both clotting and bleeding.

AB - Objective-Patients with venous thromboembolism (VTE) often require temporary warfarin interruption for an invasive procedure. The incidence of thromboembolism and bleeding related to periprocedural anticoagulation management of such patients is unknown. Methods and Results-In a protocol-driven, inception cohort design study, all VTE patients (n=775) referred for periprocedural anticoagulation management (1997-2007) were followed-up to estimate the 3-month cumulative incidence of thromboembolism and bleeding. Patients were stratified by thrombus acuity (acute, <30 days; subacute, 31-90 days; or chronic ≥91 days). Decisions to provide "bridging" low-molecular-weight heparin were based on estimated thromboembolism and bleeding risk. Low-molecular-weight heparin was more often administered in acute (87%) and subacute (81%) VTE compared to chronic VTE (59%; P<0.001). The 3-month cumulative incidence of thromboembolism (1.8%), major hemorrhage (1.8%), and mortality (1.7%) were low and did not differ by management strategy. Active cancer was the only independent predictor of thrombotic recurrence (HR, 4.86; 95% CI, 1.6-14.5; P=0.005), major hemorrhage (HR, 6.8; 95% CI, 2.1-21.7; P=0.001), and death (HR, 32.7; 95% CI, 4.3-251.2; P=0.0008). Conclusion-Thromboembolism, bleeding, and death among VTE patients in whom anticoagulation is temporarily interrupted for an invasive procedure is low. Cancer patients require particular care given their propensity for both clotting and bleeding.

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KW - Deep vein thrombosis

KW - Pulmonary embolism

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