Abstract
Objective The objective of the study was to determine if peri-operative bridging anticoagulation (AC) in patients with atrial fibrillation (AF) is beneficial or harmful.
Design Systematic review and meta-analysis.
Setting Inpatient or in-hospital setting.
Participants Adults with AF having a CHADS2 score of greater than 1 undergoing elective surgical procedure on AC were included.
Methods We performed a systemic search of multiple databases (Cochrane, Medline, PubMed) regarding studies conducted on efficacy and safety of perioperative bridging AC in patients with AF. Studies identified were reviewed by 2 authors individually before inclusion. The results were then pooled using Review Manager to determine the combined effect. Stroke/systemic embolism (SE) was considered as the primary efficacy outcome. Major bleeding was the primary safety outcome.
Results 108 potential articles were found after the systematic search. The full texts of 28 articles were retrieved for assessment of eligibility. 25 articles were excluded after full text review. Three articles met the inclusion criteria. No significant difference in stroke/SE with bridging anticoagulation was noted (risk ratio, 1.25 – 95% confidence interval [CI], 0.55 – 2.85 - Figure 3). Bridging was associated with significantly higher risk of major bleeding (risk ratio, 3.29 – 95% confidence interval [CI], 2.25 – 4.81 - Figure 5).
Conclusion An individualized approach is required when initiating peri-operative bridging AC. There is certainly a higher risk of bleeding with bridging AC and no difference in stroke/SE. However, the results cannot be extrapolated to patients who have valvular atrial fibrillation or CHADS2 score of 5 or greater.
Footnotes
↵1 both authors contributed equally
- Received December 16, 2020.
- Revision received March 26, 2020.
- Revision received July 7, 2020.
- Revision received September 8, 2020.
- Accepted September 11, 2020.
