Periprocedural Outcomes with Uninterrupted Warfarin vs. Bridge Therapy in Patients Undergoing Fistulagram
Lucero Paredes1, Nkiruka Arinze1, Jeffrey Siracuse2 1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, 88 E. Newton Street C520, Boston, MA 02118, United States. 2Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. Electronic address: Jeffrey.siracuse.org.
Background:
The management of anti-thrombotic therapy in patients undergoing minor vascular procedures remains unknown. This study aims to examine outcomes across patients who were maintained on coumadin, bridged to heparin, or had all anticoagulation held prior to fistulogram.
Methods:
This is a retrospective analysis of single institution data of patients who underwent fistulagrams from 2011 to 2017, who had an active coumadin prescription at the time of the procedure. Clinical characteristics, complications, rates of re-thrombosis, and 30-day mortality were analyzed.
Results:
Overall, 175 patients (median age: 64 years, IQR: 56-71.5; 43.4% female) were identified. The majority of patients (n=105, 60%) had all anticoagulation held prior to fistulogram, whereas 26% (n=46) remained on coumadin and 14% (n=24) were bridged to a heparin infusion pre-procedure. Rates of systemic thrombotic complications were similar among patients who did and did not have all anticoagulation held prior to fistulogram (2.9% vs. 2.2%). Similarly, the proportion of patients who returned to the operating room secondary to a bleeding complication was comparable irrespective of whether the patient remained on or held all anticoagulation (2.2% vs. 2%). Patients who held all anticoagulation had an average length of stay of 2.2 ± 4.5 days, however patients on pre-procedural bridge therapy had an average length of stay of 12.3 ± 8.8 days.
Conclusion:
Continued coumadin therapy among patients undergoing fistulogram was not associated with increased rates of thrombotic and bleeding complications nor death. This study suggests that continuation of anticoagulation therapy may be safe in patients undergoing fistulogram.
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