PB0005 - Efficacy and Safety of Perioperative Bridging Anticoagulation in Cancer and Non-Cancer Patients: Systematic Review and Meta-Analysis

Background: The emergence of oral anticoagulants such as vitamin K antagonist and direct oral anticoagulants (DOAC) has led to increased use of these agents to prevent thromboembolism in outpatient settings. However, the need to bridge or not to bridge the anticoagulation during perioperative period is an ongoing debate. Moreover, there are considerations in patients with cancer since they have distinct mechanism of thrombosis and the safety of bridging anticoagulation in such populations is uncertain. We conducted a systematic review and meta-analysis of studies on perioperative bridging anticoagulation.

Aims: This study aims to determine efficacy and safety of perioperative bridging anticoagulation in cancer and non-cancer patients.

Methods: Systematic search was done using PubMed, Cochrane, and Google Scholar search engines. The search terms used were: “anticoagulation”, “bridging vs no bridging”, and “cancer”. Studies included randomized controlled trials, and cohort studies. Review and meta-analysis were conducted in accordance with the Cochrane guidelines for systematic review. Analysis was done using Review Manager 5.4.

Results: There were six studies included, four in non-cancer patients and two in cancer patients. There were no significant differences between bridging or no bridging anticoagulation in terms of thromboembolic events both in cancer and non-cancer subgroups (combined RR=1.73, 95%CI: 0.59-5.09, Figure 1). In terms of major bleeding, the risk is higher in non-cancer patients receiving bridging anticoagulation (RR=3.05, 95% CI=1.86-5.01, Figure 2). In the cancer subgroup, there is no significant difference in bleeding events (RR=1.19, 95% CI=0.85-1.66, Figure 2). Although the studies had some heterogeneity, none of them showed superiority of bridging anticoagulation in terms of thromboembolic events and major bleeding.

Conclusion(s): Perioperative bridging anticoagulation does not reduce the risk of thromboembolic events in both cancer and non-cancer patients. In non-cancer patients, bridging anticoagulation is associated with increased risk of bleeding.