title: Bridge Therapy Outcomes in Patients With Mechanical Heart Valves.
abstract: BACKGROUND
  Bridge therapy is associated with an increased risk of major bleeding in patients with atrial fibrillation and venous thromboembolism (TE) without a corresponding reduction in TE. The benefits of bridge therapy in patients with mechanical heart valve (MHV) prostheses interrupting warfarin for invasive procedures are not well described.
  
  
  RESULTS
  A retrospective cohort study was conducted at an integrated health-care delivery system. Anticoagulated patients with MHV interrupting warfarin for invasive diagnostic or surgical procedures between January 1, 2006, and March 31, 2012, were identified. Patients were categorized according to exposure to bridge therapy during the periprocedural period and TE risk (low, medium, and high). Outcomes validated via manual chart review included clinically relevant bleeding, TE, and all-cause mortality in the 30 days following the procedure. There were 547 procedures in 355 patients meeting inclusion criteria. Mean cohort age was 65.2 years, and 38% were female. Bridge therapy was utilized in 466 (85.2%) procedures (95.2%, 77.3%, and 65.8% of high, medium, and low TE risk category procedures, respectively). The 30-day rate of clinically relevant bleeding was numerically higher in bridged (5.8%; 95% confidence interval [CI], 3.9%-8.3%) versus not bridged procedures (1.2%; 95% CI, <0.1%-6.7%; P = .102). No TEs or deaths were identified.
  
  
  CONCLUSIONS
  The use of bridge therapy is common among patients with MHV and may be associated with increased bleeding risk. Further research is needed to determine whether bridge therapy reduces TE in patients with MHV interrupting warfarin for invasive procedures.
authors.affiliation: 1 Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA.|2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.affiliation: 3 Clinical Pharmacy Department, Veterans Administration, Colorado Springs, CO, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Meisinger
authors.affiliation: 4 Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Witt
authors.affiliation: 1 Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA.|2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: 5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Douketis
authors.affiliation: 1 Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA.|2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Clark
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014859:Warfarin
keywords: anticoagulants; bleeding; heart valve; surgery; thrombosis