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New research · Internal Medicine
ANZ journal of surgery · 4h
Cohort studyANZ journal of surgery · 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
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Internal MedicineCohort study

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 · 2026
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.

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