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Journal of General Internal Medicine

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01-04-2019 | Stroke | Original Research

Cost-Effectiveness of Bridging Anticoagulation Among Patients with Nonvalvular Atrial Fibrillation

Authors: Matthew A. Pappas, MD, MPH, Geoffrey D. Barnes, MD, MSc, Sandeep Vijan, MD, MS

Published in: Journal of General Internal Medicine | Issue 4/2019

Abstract

Background

Bridging anticoagulation is commonly prescribed to patients with atrial fibrillation during initiation and interruption of warfarin. Guidelines recommend bridging patients at high risk of stroke, while a recent randomized trial demonstrated overall harm in a population at comparatively low risk of ischemic stroke. Theory suggests that patients at high risk of stroke and low risk of hemorrhage may benefit from bridging, but data informing patient selection are scant.

Objective

To estimate the utility and cost-effectiveness of bridging anticoagulation among patients with nonvalvular atrial fibrillation, stratified by thromboembolic and hemorrhagic risk

Design

Cost-effectiveness analysis with lifelong time horizon, from the perspective of a third-party payer

Main Measures

Quality-adjusted life years (QALYs) per bridged patient; US dollars per QALY gained

Key Results

Unselected patients with nonvalvular atrial fibrillation may be harmed by bridging anticoagulation. Hospital admission for bridging is almost never cost-effective, and generally harmful. Among patients carefully selected by both thromboembolic and hemorrhagic risks, outpatient bridging can be beneficial and cost-effective. Results were sensitive to how effectively heparin products reduce stroke risk.

Conclusions

Outpatient bridging anticoagulation can be beneficial and cost-effective for a subset of patients with nonvalvular atrial fibrillation during interruption or initiation of warfarin. Admission for bridging should be avoided.

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Title: Cost-Effectiveness of Bridging Anticoagulation Among Patients with Nonvalvular Atrial Fibrillation
Authors: Matthew A. Pappas, MD, MPH
Geoffrey D. Barnes, MD, MSc
Sandeep Vijan, MD, MS
Publication date: 01-04-2019
Publisher: Springer US
Keywords: Stroke
Atrial Fibrillation
Warfarin
Published in: Journal of General Internal Medicine / Issue 4/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-018-4796-9

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Key Results

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