Bridging therapy with low-molecular-weight heparin is commonly used for patients with acute stroke of cardioembolic origin, bit this approach may increase the incidence of intracerebral bleeding and worsen outcomes for these patients. In a recent observational study, outcomes (defined as a combination of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding and major extracerebral bleeding detected 90 days following acute stroke) were compared for patients who received bridging therapy and those who did not. 371 (20%) of 1,810 patients undertook full dose bridging therapy with low-molecular-weight heparin, which was found to be inversely correlated with leukoaraiosis (an abnormal change in the appearance of white matter in the brain near the lateral ventricles, and also older age. The combined outcome was seen in 11.3% of bridged patients and 5.0% of non-bridged patients (P = 0.0001), with the bridging therapy found to be associated with an increased risk of the combined end point (odds ratio, 2.3; 95% CI, 1.4–3.7; P<0.0001). Those receiving bridging LMWH also had a higher risk of ischemic stroke (OR 2.2; 95% CI, 1.3–3.9; P=0.005) and haemorrhagic stroke (OR 2.4; 95% CI, 1.2–4.9; P=0.01) end points independently. The study, published in the AHA Journal Stroke, suggests that patients with low-molecular-weight heparin bridging have an increased risk of early ischemic recurrence and hemorrhagic transformation in comparison to non-bridged patients. The original report can be accessed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh