Category: Federal Forum Posters
Purpose: Warfarin is often held in patients undergoing elective invasive procedures. Instead, patients administer parenteral anticoagulants, known as “bridging,” to reduce the risk of thromboembolism. However, recent data shows bridging most patients may cause more harm than benefit. The Veterans Integrated System Network (VISN) 1 released an anticoagulation interruption guideline adapted from American College of Chest Physicians (CHEST) and American College of Cardiology (ACC) guidelines to provide direction on individualized bridging therapy. This study will evaluate prescribing patterns of anticoagulation bridging in warfarin patients undergoing an elective invasive procedure in the VA Connecticut Healthcare System (VACT) utilizing the VISN 1 guideline.
Methods: A retrospective chart review will be conducted on all veterans at VACT with a warfarin prescription who underwent an elective invasive procedure and received bridging between January 2018 and April 2018. Eligible patients must have atrial fibrillation and be prescribed warfarin for prevention of cardioembolic stroke. Patients with mechanical heart valves will be excluded. Information will be retrieved from the VA Computerized Patient Record System. Data collected will include age, gender, ethnicity, weight, creatinine clearance, HAS-BLED score, procedure type, bridging dose, CHA2DS2-VASc and CHADS2 score along with whether they have valvular heart disease or have had a stroke or transient ischemic attack within the past three months. The primary endpoint will be whether patients have been appropriately bridged based on the recent data used to create the VISN 1 guideline. Secondary endpoints will be if patients experienced thromboembolism or major bleeding within 30 days following the procedure.
Results: Not applicable
Conclusion: Not applicable
Micaela Leblanc– PGY1 Pharmacy Practice Resident, VA Connecticut Healthcare System, Manville, RI