Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial

BRUISE CONTROL Investigators

doi:10.1016/j.ijcard.2019.04.066

Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial

BRUISE CONTROL Investigators

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Background: Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated. Methods: A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated. Results: All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery. Conclusions: Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible. Trial registration: clinicaltrials.gov Identifier: (NCT00800137)

Original language	English
Pages (from-to)	87-93
Number of pages	7
Journal	International Journal of Cardiology
Volume	288
DOIs	https://doi.org/10.1016/j.ijcard.2019.04.066
Publication status	Published - Aug 1 2019
Externally published	Yes

Bibliographical note

Funding Information:
Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Québec - Santé (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario). We thank Leslie Carlin and Karen MacDonald for central study co-ordination and Keri O'Reilly for data entry. We thank staff at the UOHI CVS Research Methods Center for database and statistical support/analysis: Lily Chen, My-Linh Tran, Jordan Bernick, and Liz Yetisir. Drs Essebag and Birnie had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Essebag, AlTurki, Proietti, Birnie. Essebag, AlTurki, Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne, Birnie. Essebag, AlTurki. Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne. Essebag, AlTurki, Birnie. Essebag, Birnie. Essebag, Birnie.

Funding Information:
Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Québec - Santé (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario).

Publisher Copyright:
© 2019 Elsevier B.V.

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article
Multicenter Study
Randomized Controlled Trial

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10.1016/j.ijcard.2019.04.066

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@article{b61db993c8c14e1e86f11251cbee8df5,

title = "Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial",

abstract = "Background: Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated. Methods: A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated. Results: All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery. Conclusions: Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible. Trial registration: clinicaltrials.gov Identifier: (NCT00800137)",

author = "{BRUISE CONTROL Investigators} and Vidal Essebag and Ahmed AlTurki and Riccardo Proietti and Healey, {Jeff S.} and Wells, {George A.} and Atul Verma and Krahn, {Andrew D.} and Simpson, {Christopher S.} and Felix Ayala-Paredes and Benoit Coutu and Richard Leather and Kamran Ahmad and Satish Toal and John Sapp and Marcio Sturmer and Katherine Kavanagh and Eugene Crystal and Leiria, {Tiago L.L.} and Colette Seifer and Claus Rinne and David Birnie",

note = "Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Qu{\'e}bec - Sant{\'e} (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario). We thank Leslie Carlin and Karen MacDonald for central study co-ordination and Keri O'Reilly for data entry. We thank staff at the UOHI CVS Research Methods Center for database and statistical support/analysis: Lily Chen, My-Linh Tran, Jordan Bernick, and Liz Yetisir. Drs Essebag and Birnie had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Essebag, AlTurki, Proietti, Birnie. Essebag, AlTurki, Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne, Birnie. Essebag, AlTurki. Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne. Essebag, AlTurki, Birnie. Essebag, Birnie. Essebag, Birnie. Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Qu{\'e}bec - Sant{\'e} (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario). Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = aug,

day = "1",

doi = "10.1016/j.ijcard.2019.04.066",

language = "English",

volume = "288",

pages = "87--93",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation

T2 - A secondary analysis of the BRUISE CONTROL trial

AU - BRUISE CONTROL Investigators

AU - Essebag, Vidal

AU - AlTurki, Ahmed

AU - Proietti, Riccardo

AU - Healey, Jeff S.

AU - Wells, George A.

AU - Verma, Atul

AU - Krahn, Andrew D.

AU - Simpson, Christopher S.

AU - Ayala-Paredes, Felix

AU - Coutu, Benoit

AU - Leather, Richard

AU - Ahmad, Kamran

AU - Toal, Satish

AU - Sapp, John

AU - Sturmer, Marcio

AU - Kavanagh, Katherine

AU - Crystal, Eugene

AU - Leiria, Tiago L.L.

AU - Seifer, Colette

AU - Rinne, Claus

AU - Birnie, David

N1 - Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Québec - Santé (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario). We thank Leslie Carlin and Karen MacDonald for central study co-ordination and Keri O'Reilly for data entry. We thank staff at the UOHI CVS Research Methods Center for database and statistical support/analysis: Lily Chen, My-Linh Tran, Jordan Bernick, and Liz Yetisir. Drs Essebag and Birnie had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Essebag, AlTurki, Proietti, Birnie. Essebag, AlTurki, Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne, Birnie. Essebag, AlTurki. Healey, Wells, Verma, Krahn, Simpson, Ayala-Paredes, Coutu, Leather, Ahmad, Toal, Sapp, Sturmer, Kavanagh, Crystal, Leiria, Seifer, Rinne. Essebag, AlTurki, Birnie. Essebag, Birnie. Essebag, Birnie. Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research (CIHR), a CIHR Clinician Scientist Award (Dr. Essebag), a Clinical Research Scholar Award (Dr. Essebag) from Fonds de recherche du Québec - Santé (FRQS), and an Innovations grant from the University of Ottawa Heart Institute Academic Medical Organization Alternate Funding Program (funded by the Ministry of Health of Ontario). Publisher Copyright: © 2019 Elsevier B.V.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated. Methods: A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated. Results: All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery. Conclusions: Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible. Trial registration: clinicaltrials.gov Identifier: (NCT00800137)

AB - Background: Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated. Methods: A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated. Results: All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery. Conclusions: Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible. Trial registration: clinicaltrials.gov Identifier: (NCT00800137)

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JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial

Abstract

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PubMed: MeSH publication types

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