Bleeding Risk During Prolonged Dual Anticoagulation With Warfarin and Low-Molecular-Weight Heparin: A…

Cohort studyANZ journal of surgery· Aug 2026

Bleeding Risk During Prolonged Dual Anticoagulation With Warfarin and Low-Molecular-Weight Heparin: A Retrospective Single-Centre Study.

Shing Fung Oscar Miao, Wen Kwang Lim, Seok Lim

Venous ThromboembolismCohort studyClinical practiceQ3IF 1.0

About 1 in 6 patients bled during warfarin-low-molecular-weight heparin bridging re-initiation

Bleeding Risk During Prolonged Dual Anticoagulation With Warfarin and Low-Molecular-Weight Heparin: A Retrospective Single-Centre Study.

Shing Fung Oscar Miao … Seok Lim

ANZ journal of surgery · Aug 2026 · Q3 in General Medicine

Background

Warfarin remains the anticoagulant of choice for selected high-risk patients [1].

Methods

We conducted a retrospective cohort study on patients managed through the Hospital-in-the-Home (Hospital-in-the-Home) service at a tertiary centre in Melbourne, Australia.

n = 129 patients

Results

21 of 129 bridged patients had a bleeding event, most mild

RR 2.96 (95% CI 1.15 to 7.60)

null 1

1.15

7.60

CI excludes the null - significant

More results

Most bleeding was managed in the community with only two requiring procedural intervention.

Bleeding occurred at a median of 6 days of dual therapy.

More results

Previous long-term warfarin use, renal impairment, higher target INR and elevated anti-Xa exposure were associated with bleeding; target INR and anti-Xa remained independently associated with bleeding on multivariable analysis.

“

Conclusion

Bleeding risk was more strongly associated with patient- and treatment-related risk factors than bridging duration alone. These findings support risk-stratified warfarin re-initiation and early monitoring during dual therapy.

Bleeding Risk During Prolonged Dual Anticoagulation With Warfarin and Low-Molecular-Weight Heparin: A Retrospective Single-Centre Study.

Bleeding Risk During Prolonged Dual Anticoagulation With Warfarin and Low-Molecular-Weight Heparin: A Retrospective Single-Centre Study.

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