Journal of Blood Disorders & Transfusion

Perioperative bridging therapy in patients with atrial fibrillation on Warfarin: Examining current practice and implementing evidence based changes

5^th World Hematologists Congress

August 18-19, 2016 London, UK

Helen Bartlett and Gillian Loweon

University Hospitals Birmingham NHS Foundation Trust, UK

Posters & Accepted Abstracts: J Blood Disord Transfus

Abstract:

Introduction: It has long been uncertain whether bridging therapy is necessary for patients with atrial fibrillation (AF). The British Journal of Hematology (BJH) and The American College of Chest Physicians (CHEST) recommend no bridging therapy in low risk patients (no stroke/TIA history). Those with a stroke/TIA in the past three months or a CHA2DS2-VASc score �?�3 should be considered for bridging whilst those at high risk (stroke/TIA in past three months) should be bridged. However, recent RCT findings from the BRIDGE study have challenged these guidelines, instead recommending that bridging should only be undertaken in patients with a stroke/TIA in past three months. Aims: Audit the bridging plans for patients with AF undergoing a procedure at University Hospital Birmingham to determine if previous BJH/CHEST guidelines were met and whether action is required to bring practice in line with new standards set by BRIDGE. Methods: Bridging plans for the first 110 patients seen at least three months previously were analyzed. Results: 90% (11/110) of patients were bridged according to BJH/CHEST guidelines whilst 88% (97/110) according to BRIDGE recommendations. Conclusion: University Hospital Birmingham achieved good adherence to guidelines for low and high risk patients. However action is required to ensure intermediate risk patients are no longer bridged in line with new BRIDGE recommendations. A new system was incorporated into the hospital database whereby the referrer must clearly identify patients with a stroke/TIA in the past three months. Only these patients will be bridged unless another non AF related indication exists.

Biography :

Helen Bartlett is currently a Medical student at the University of Birmingham, UK. She is especially interested in hematology and has attended medical student teaching days run by the British Journal of Hematology. She spent her elective in three hematology laboratories in Sri Lanka and UK with the objective of critically comparing the range and capabilities of the techniques available.

Email: hrb209@bham.ac.uk