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To perform a meta-analysis to compare the effects of bridging therapy on the risk of major bleeding and thromboembolic events.
We searched PubMed, EMBASE and the Cochrane library from January 2005 to July 2016. Studies were included if they reported clinical outcomes of patients receiving heparin bridging therapy during interruption of oral anticoagulant for operations. Data were pooled using random-effects modeling.
A total of 25 studies, including 19 observational studies and 6 randomized controlled trials, were finally included in this analysis. Among the 35,944,patients, 10,313 patients were assigned as heparin bridging group, and the other 25,631 patients were non-heparin bridging group. Overall, compared with patients without bridging therapy, heparin bridging therapy increased the risk of major bleeding (OR=3.27, 95%CI:2.00∼5.34), minor bleeding (OR=1.65, 95%CI:1.10∼2.47) and overall bleeding (OR=2.92, 95%CI:1.88∼4.55). While there was no significant difference in thromboembolic events (OR=0.91, 95%CI:0.42∼1.96), stroke or transient ischemic attack (OR=1.45, 95%CI:0.93∼2.26,) or all-cause mortality (OR=0.63, 95%CI:0.27∼1.49).
The heparin-bridging therapy increased risk of major, overall and minor bleeding without decreasing the risk of thromboembolic events and all cause death compared to non-heparin bridging.