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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Bridging in High Thromboembolic and Venous Thromboembolism Risk Patients on Direct Oral Anticoagulants: Implications for Anticoagulation Stewardship (BRAVO-HTV) Itea Thomallari1, Thaddaus R.Hellwig1, 3, Shannon D.Wegleitner1, Amanda C.Owen1, Michael P.Gulseth1, 2. 1Sanford USD Medical Center, Sioux Falls, SD, USA.2University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.3South Dakota State University College of Pharmacy, Sioux Falls, SD, USA |
Abstract
Background The use of preoperative heparin/low molecular-weight heparin (LMWH) bridging has been investigated in patients undergoing elective surgery or procedures, but the prospective, randomized data has been limited to patients on warfarin with atrial fibrillation and mechanical heart valves. There is no prospective data evaluating patients on direct oral anticoagulants (DOACs) who are high venous thromboembolic risk and require therapy interruption for an invasive procedure. The 2022 American College of Chest Physicians guideline for perioperative management of antithrombotic therapy contains recommended hold times for DOACs, however these were derived from a single armed trial in atrial fibrillation patients. The guidelines also discourage parenteral bridging for DOAC patients based on data from clinical trials in patients with atrial fibrillation. Little data exists on how to best manage patients at high venous thromboembolic risk who require DOAC therapy interruption for invasive procedures. Objectives This is a retrospective, observational, multicenter, non-inferiority cohort study comparing high risk venous thromboembolism (VTE) patients who had DOAC anticoagulation interrupted for an invasive surgical procedure placed in cohorts based on if they received treatment dose LMWH pre-procedure. The primary outcome is a composite of major bleeding as defined by the International Society for Thrombosis and Hemostasis (ISTH) or repeat VTE or extension of initial thrombus within 30 days. Secondary outcomes include any bleeding, clinically relevant non-major bleeding, minor bleeding, VTE alone, incidence of myocardial infarction, cerebrovascular accident, or systemic embolism. Methods Patients who are 18 years old with a history of VTE in the past 3 months on a DOAC who required interruption for an invasive, high bleeding risk procedure from September 1, 2020 – September 1, 2025, are eligible for this study. Patient cohorts will be determined by if the patient received pre-operative LMWH in a therapeutic dose undergoing invasive high bleeding risk procedure. Exclusion criteria are a creatinine clearance <20 mL/min or any of the following diagnosis: triple positive antiphospholipid syndrome, moderate to severe mitral valve stenosis, or prior history of mechanical aortic or mitral heart valve. Patients without a documented last dose of DOAC therapy will also be excluded. Results Research currently in progress. Pharmacy Thrombosis and Hemostasis Management PGY-2 Residency project. Conclusions Research results will be presented in poster form.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.