Purpose: The effect of education regarding new evidence in periprocedural anticoagulation, with a focus on reducing use in patients at only moderate thromboembolic risk, is presented.
Methods: A retrospective cohort analysis and quasiexperimental design were used. The initial review identified the current state of practice regarding bridging anticoagulation. Education was then provided to primary care providers and pharmacists on recent evidence. A subsequent review was completed to assess the impact of this education on clinical decision-making. Inclusion criteria were adults taking warfarin for an indication of mechanical heart valve, atrial fibrillation (AF), or history of venous thromboembolism (VTE) and required interruption of warfarin therapy to undergo a planned procedure. Patients were excluded if their anticoagulation was managed outside of the Minneapolis Veterans Affairs Anticoagulation Clinic.
Results: The overall rate of bridging decreased from 38.8% to 24.8% (14% decrease; 95% confidence interval [CI], 2-26%; p = 0.028) confidence interval [CI], 0.02-0.26; p = 0.026) after educational intervention. This decrease occurred in the moderate thromboembolic risk group, in which the bridging rate decreased from 63.8% to 30.2% (33.6% decrease; 95% CI, 14-53%; p = 0.001). Bleeding complications occurred more frequently in patients who received bridging. There were no thromboembolic complications.
Conclusion: The majority of patients at moderate thromboembolic risk were previously receiving bridging until new evidence was released indicating that the risks may outweigh any benefits. The provision of education to primary care physicians and pharmacy staff regarding this new evidence in the area of periprocedural anticoagulation management significantly reduced the amount of bridging used for patients on warfarin for AF or a history of VTE who were at moderate thromboembolic risk.
Keywords: anticoagulants; atrial fibrillation; clinical decision-making; pharmacists; venous thromboembolism; warfarin.
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