Abstract 154: Bridging to Warfarin With Direct Oral Anticoagulant Agents
Background: Anticoagulation bridging using LMWH remains a common practice to mitigate the Warfarin’s delayed onset of action. However, LMWH often creates resistance from patients given cost, fear to injections, or in patients already on direct oral anticoagulant agents (DOACs), cost coverage that demand agent change. In such circumstances, the possibility of bridging using DOACs has been adopted.
Aim: To characterize the outcomes and cost benefit for patients who were bridged to Warfarin using a DOAC.
Methods: We identified a case series of patients who used DOACs for bridging to Warfarin. Primary outcome was major hemorrhage and thrombosis recurrence identified 30 and 60 days after initial bridging therapy was initiated. Categorical variables were presented as percentages, continuous variables as median and range. Chi Square or Student T were used as appropriate.
Results: A total of nineteen patients were included (Men = 42%, Age = 66.3 (32-93), BMI = 29 (19.5-44.6)). Twelve patients received Apixaban (63%), and seven patients received Rivaroxaban (37%). Reasons to avoid low molecular weigh heparin were patient’s preference (53%), changing indication (32%), interaction (10%), and cost (5%) The average time for successful bridging was 13.2 days (5-29). No episodes of major bleeding, deep venous thrombosis, pulmonary embolism or minor bleeding were registered after 30 and 60 days of initiation of bridging therapy. Average cost of bridging therapy with DOAC was 158.3 USD (Range 21.1-407.9). Estimated cost of bridging therapy with LMWH and current pricing would have been 652.4 US dollars (294-1421).
Conclusion: Bridging strategy with direct oral anticoagulant agents seems to be a safe, cost-effective approach in patients receiving oral Warfarin. Moreover, this alternative is reasonable for patients with aversion or lack of social support to administer injections. A larger study is necessary to further explore these findings.
Author Disclosures: L. Diaz Quintero: None. A. Tafur: None.
- © 2017 by American Heart Association, Inc.