Effectiveness of perioperative anticoagulation interruption without heparin bridging on thromboembolic events in patients with atrial fibrillation undergoing elective invasive procedures: a systematic review protocol

Abstract

Objective: This review will determine whether withholding heparin bridging is superior to bridging in patients with atrial fibrillation requiring temporary interruption of anticoagulation therapy in the perioperative period of an elective invasive procedure. Introduction: Atrial fibrillation is the most commonly diagnosed clinical arrhythmia. It is an important cause of cardioembolic events, requiring the use of oral anticoagulation in most patients. It is unclear whether heparin bridging during temporary interruption of anticoagulants has superior outcomes compared with no bridging in the perioperative setting. Inclusion criteria: This review will consider studies that compare adults aged 18 years or older; diagnosed with atrial fibrillation; undergoing elective invasive procedures; and who have had oral anticoagulants temporarily withheld with heparin bridging with patients without heparin bridging. Participants will be excluded if they had an alternative reason for anticoagulation or were admitted for emergency surgery. Outcomes will include arterial or venous thromboembolism (including stroke, transient ischemic attack, systemic embolism), major bleeding events, non-major bleeding events, length of hospital stay, and all-cause mortality. Methods: The review will follow the JBI methodology for systematic reviews of effectiveness. Databases including MEDLINE, Embase, CINAHL, and CENTRAL will be searched for randomized and non-randomized trials from inception until the present. Two independent reviewers will screen citations by title and abstract, and again at full text. Risk of bias will be assessed using the JBI critical appraisal instrument, and data will be extracted using a modified extraction tool. Results will be synthesized using a random effects meta-analysis and presented in a forest plot. Heterogeneity will be tested for using the standard χ2 and I 2 tests. Overall certainty of evidence will be evaluated using the GRADE approach. Review registration: PROSPERO CRD42022348538