Interruption Of Anticoagulation In Patients Research Articles

Inferior Vena Cava Filter Use at a Large Community Hospital: A Cross-Sectional Analysis

Introduction: Inferior vena cava (IVC) filters are considered among patients who have sustained a recent lower extremity deep vein thrombosis (DVT) and/or pulmonary embolism (PE) with a contraindication to anticoagulation. IVC filter use has risen in recent decades despite a lack of data on the effectiveness of IVC filters in reducing venous thromboembolism (VTE)-related mortality. Moreover, IVC filters may be associated with significant morbidity, including filter migration, IVC thrombosis, and fatal bleeding. Prolonged insertion of an IVC filter risks endothelialization which renders later attempts at removal ineffective, and raises the risk of complications. In this study, we aimed to characterize the pattern of IVC filter use at a large community-based hospital. Specifically, we characterized the indications for IVC filter insertion, rates of IVC filter removal, and filter-associated complications. Methods: A retrospective cohort study of adult patients (>18 years) who received an IVC filter between January 1, 2005 - February 28, 2022 at Windsor Regional Hospital (WRH), which is a large community-based hospital with academic affiliations in Southwestern Ontario, Canada. Data were collected using RedCAP software and analyzed using descriptive methods. Results: To date, we have reviewed 89 patient charts from 2019-2022. Patients with IVC filters inserted through WRH were most often male (58.4%) with a median age of 68 years. The most common indications for IVC filters included recent VTE (DVT and/or PE within 3 months) and active bleeding (43.8%), and recent VTE with a need for anticoagulation interruption for surgery (32.6%). Approximately 21% (19 patients) of IVC filters were inserted for indications outside recommended guidelines, including: need for interruption of anticoagulation in patients with a remote history of VTE (31.6%) or prior to surgery (15.8%), recent VTE & active bleed but anticoagulant therapy not discontinued (21.1%), surgical prophylaxis (10.5%), recent VTE & risk of bleeding with no active bleed (10.5%), failure of anticoagulation (5.3%), and massive PE with residual DVT (5.3%). Only 34.8% of patients had successful removal of their IVC filter with an average of 1.2 attempts at filter removal per patient. At least 4 patients (4.5%) have experienced complications relating to their IVC filter, including IVC thrombotic occlusion (50%) and IVC filter migration (50%). Conclusions: Approximately 21% of IVC filters were inserted for indications that fall outside of current guidelines at a large community-based hospital in Ontario, Canada. Moreover, 65% of IVC filters were not removed which is consistent with rates reported in other studies, and significantly raises the risk of IVC filter complications. Given that the majority of patient care occurs in the community setting, further efforts are needed to understand patterns of IVC filter use at other community hospitals. As well, our findings further support the need for development of concrete guidelines on indications for IVC filter use and monitoring practices. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Przerywanie terapii przeciwzakrzepowej u pacjentów poddawanych planowym zabiegom chirurgicznym

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Łętek A, Zandecki Ł, Janion-Sadowska A, Polewczyk A. Interruption of anticoagulation in patients undergoing elective surgical procedures. Medical Studies/Studia Medyczne. 2020;36(1):51-59. doi:10.5114/ms.2020.94089. APA Łętek, A., Zandecki, Ł., Janion-Sadowska, A., & Polewczyk, A. (2020). Interruption of anticoagulation in patients undergoing elective surgical procedures. Medical Studies/Studia Medyczne, 36(1), 51-59. https://doi.org/10.5114/ms.2020.94089 Chicago Łętek, Agnieszka, Łukasz Zandecki, Agnieszka Janion-Sadowska, and Anna Polewczyk. 2020. "Interruption of anticoagulation in patients undergoing elective surgical procedures". Medical Studies/Studia Medyczne 36 (1): 51-59. doi:10.5114/ms.2020.94089. Harvard Łętek, A., Zandecki, Ł., Janion-Sadowska, A., and Polewczyk, A. (2020). Interruption of anticoagulation in patients undergoing elective surgical procedures. Medical Studies/Studia Medyczne, 36(1), pp.51-59. https://doi.org/10.5114/ms.2020.94089 MLA Łętek, Agnieszka et al. "Interruption of anticoagulation in patients undergoing elective surgical procedures." Medical Studies/Studia Medyczne, vol. 36, no. 1, 2020, pp. 51-59. doi:10.5114/ms.2020.94089. Vancouver Łętek A, Zandecki Ł, Janion-Sadowska A, Polewczyk A. Interruption of anticoagulation in patients undergoing elective surgical procedures. Medical Studies/Studia Medyczne. 2020;36(1):51-59. doi:10.5114/ms.2020.94089.

Periprocedural interruption of anticoagulation in patients with cancer‐associated venous thromboembolism: An analysis of thrombotic and bleeding outcomes

Unlabelled Box BackgroundPatients with cancer are at high risk for venous thromboembolic events. Venous thromboembolism (VTE) can lead to significant morbidity among patients with cancer, and is estimated to be one of the leading causes of death among cancer patients. Patients with cancer often require invasive procedures for biopsy or therapeutic purposes. There is a lack of data on postoperative outcomes following interruption of anticoagulation in this population. ObjectiveTo assess 30‐day postoperative thromboembolic and major bleeding complication rates following the perioperative interruption of anticoagulation in patients with cancer‐associated VTE. MethodsWe conducted a retrospective self‐controlled case series study with patients with cancer‐associated VTE undergoing perioperative interruption of anticoagulation at a dedicated tertiary‐care anticoagulation clinic for invasive procedures between January 2013 and March 2018. The primary efficacy and safety outcomes were the 30‐day postoperative rates of VTE and major bleeding, respectively. The secondary outcomes included the 30‐day rates of clinically relevant non‐major bleeding (CRNMB) and overall mortality. Patients undergoing multiple perioperative anticoagulation interruptions were included. ResultsOne hundred and forty‐six patients undergoing 171 periprocedural interruptions were included in our cohort. The 30‐day rates of VTE and major bleeding were both 4.1% (95% confidence interval [CI] 2.0‐8.2). The 30‐day rate of CRNMB was 2.9% (95% CI 1.3‐6.7) and the 30‐day overall mortality rate was 0.6% (95% CI 0.1‐3.4). There were no fatal postoperative VTE or major bleeding events. ConclusionsThe periprocedural interruption of anticoagulation in patients with cancer‐associated VTE is associated with high postoperative rates of VTE and major bleeding. Patients with cancer‐associated VTE may require closer follow‐up for VTE and bleeding complications after invasive procedures.

Periprocedural Interruption of Anticoagulation in Patients with Cancer-Associated VTE: An Analysis of Thrombotic and Bleeding Outcomes

Background: Approximately 10-20% of patients with venous thromboembolic events (VTE) have underlying malignancy. VTE is considered the second leading cause of death in patients with cancer, and patients with cancer-associated VTE are at higher risk of anticoagulant-related bleeding. Although patients with cancer often undergo diagnostic or therapeutic invasive procedures, there is a paucity of data on adverse outcomes following the periprocedural interruption of anticoagulation in this patient population.Methods: We did a single-center, retrospective chart review of consecutive patients with cancer-associated VTE who had periprocedural interruption of anticoagulation for invasive procedures between November 2015 and March 2018. Perioperative interruption of warfarin/low-molecular-weight heparin was done as per CHEST guidelines (Douketis et al. Chest 141(2 Suppl). Heparin bridging anticoagulation was used only for patients with recent (< 3 months) VTE. Perioperative interruption of direct oral anticoagulants (DOACs) was done as per Thrombosis Canada guidelines, with anticoagulation held for 3 half-lives prior to low bleeding risk procedures and 5 half-lives for high bleeding risk procedures. Active cancer was defined as per the HOKUSAI VTE CANCER trial (Raskob et al. NEJM 378(7)). Primary outcomes were 30-day post-operative rates of VTE and major bleeding. Secondary outcomes were 30-day post-operative rates of clinically relevant non-major bleeding (CRNMB) and mortality. Major bleeding and CRNMB were defined according to ISTH definitions. Data are reported on a per-interruption basis. Herein, we present an interim analysis of results.Results: To date, 82 perioperative interruptions are included, of whom 69.5% were receiving a DOAC. Mean age of the cohort was 65.8 years, 62.2% were male, 92.6% had active cancer and 41.5% had metastatic cancer. Thrombocytopenia (platelet count < 100 x 106/L) was present in 12.2% of interruptions. Procedures were stratified as high bleeding risk in 65.9% of cases. The 30-day rates of thromboembolism and major bleeding were both 3.70 % (95% confidence interval [CI] 1.25 to 10.2%), as was the 30-day rate of CRNMB. There were no deaths during the 30-day follow-up period.Conclusions: The periprocedural interruption of anticoagulation in patients with cancer-associated VTE appears to be associated with high rates of post-operative thrombotic and bleeding complications. Prospective studies are required to better quantify the risks of periprocedural anticoagulation interruption in this patient population. DisclosuresShaw:Portola Pharmaceuticals: Research Funding. Douketis:BMS: Other: Advisory Board; Janssen: Consultancy; Bayer: Other: Advisory Board; Pfizer: Other: Advisory Board; Daiichi-Sankyo: Other: Advisory Board; Portola: Other: Advisory Board; Astra-Zeneca: Other: Advisory Board; Sanofi: Consultancy, Other: Advisory Board; Biotie: Other: Advisory Board; Boehringer-Ingelheim: Consultancy, Other: Advisory Board, Research Funding; The Medicines Company: Other: Advisory Board. Carrier:Pfizer: Honoraria; Bayer: Honoraria; BMS: Honoraria, Research Funding; Leo Pharma: Research Funding.

3. Abstract Title: Periprocedural Interruption of Anticoagulation in Patients with Cancer-Associated VTE: An Analysis of Thrombotic and Bleeding Outcomes

3. Abstract Title: Periprocedural Interruption of Anticoagulation in Patients with Cancer-Associated VTE: An Analysis of Thrombotic and Bleeding Outcomes

Clinical events after interruption of anticoagulation in patients with atrial fibrillation: An analysis from the ENGAGE AF-TIMI 48 trial

BackgroundPatients with atrial fibrillation (AF) who interrupt anticoagulation are at high risk of thromboembolism and death. Methods and resultsPatients enrolled in the ENGAGE AF-TIMI 48 trial (randomized comparison of edoxaban vs. warfarin) who interrupted study anticoagulant for >3 days were identified. Clinical events (ischemic stroke/systemic embolism, major cardiac and cerebrovascular events [MACCE]) were analyzed from day 4 after interruption until day 34 or study drug resumption. During 2.8 years median follow-up, 13,311 (63%) patients interrupted study drug for >3 days. After excluding those who received open-label anticoagulation during the at-risk window, the population for analysis included 9148 patients. The rates of ischemic stroke/systemic embolism and MACCE post interruption were substantially greater than in patients who never interrupted (15.42 vs. 0.26 and 60.82 vs. 0.36 per 100 patient-years, respectively, padj < .001). Patients who interrupted study drug for an adverse event (44.1% of the cohort), compared to those who interrupted for other reasons, had an increased risk of MACCE (HRadj 2.75; 95% CI 2.02–3.74, p < .0001), but similar rates of ischemic stroke/systemic embolism. Rates of clinical events after interruption of warfarin and edoxaban were similar. ConclusionInterruption of study drug was frequent in patients with AF and was associated with a substantial risk of major cardiac and cerebrovascular events over the ensuing 30 days. This risk was particularly high in patients who interrupted as a result of an adverse event; these patients deserve close monitoring and resumption of anticoagulation as soon as it is safe to do so.

Interruption of Anticoagulation in Patients with HeartMate 3 - A Safety Analysis

Interruption of Anticoagulation in Patients with HeartMate 3 - A Safety Analysis

Use and Outcomes Associated With Bridging During Anticoagulation Interruptions in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)

Use and Outcomes Associated With Bridging During Anticoagulation Interruptions in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)

Bridging with enoxaparin using a half-therapeutic dose regimen: safety and efficacy

Low molecular weight heparin is widely used during the interruption of long-term oral anticoagulation in patients undergoing surgery. The optimal dose is still a matter of debate. The 8th ACCP Guidelines primarily recommend therapeutic-dose or low-dose low molecular weight heparin after stratification of the thromboembolic risk. We investigated the efficacy and safety of a standardized bridging therapy with enoxaparin in a half-therapeutic dose in patients with a target INR of 2,0 to 3,0. In our prospective registry we studied 198 consecutive patients receiving oral anticoagulant therapy with phenprocoumon and a planned surgery. Phenprocoumon was stopped 7 days before surgery and after reaching an INR less than 2,0 all patients received enoxaparin in a half-therapeutic dose (1 x 1 mg / kg body weight (bw)/day) until the day before surgery. Enoxaparin was continued with the same dose split into 2 x 0,5 mg / kg bw / day after the procedure. Phenprocoumon was resumed within day 1 to 14 after surgery depending on the bleeding risk as determined by the surgeon. All patients were followed up for 28 days after surgery. Major surgery was performed in 148 patients (75 %). 175 patients (88 % of the total) had an intermediate thromboembolic risk. On average, enoxaparin was administered for 19,5 days. One patient (0,5 %) experienced arterial thrombosis after surgery, and one patient (0,5 %) required a second surgical intervention due to severe bleeding. In patients receiving oral anticoagulant therapy with a target INR of 2,0-3,0 and at an intermediate risk of thromboembolic events who require interruption of oral anticoagulant therapy a half therapeutic dose of enoxaparin seems to be safe and effective for bridging.