Bridge therapy

Refers to use of a short acting anticoagulant during a periprocedural period for patients at high risk of venous thromboembolism recurrence to minimize risk in those patients receiving warfarin.

Reduces exposure to subtherapeutic anticoagulation for 3-4 days during warfarin therapy withdrawal before the procedure and 5 or more days after the procedure during warfarin reinitiation.

Risks for bleeding or VTE with bridge therapy in patients with history of VTE on warfarin is lacking.

Most studies for risk of VTE in such patients on warfarin treatment are from patients at risk for stroke with atrial fibrillation or mechanical heart valves.

Studies suggest for the management of patients with atrial fibrillation, without mechanical valves, and who were anticoagulated with warfarin and who are undergoing common operations or procedures not considered high-risk for thrombosis, a non-bridging strategy results in a fewer major and minor bleeding complications and is noninferior as regards the risk for arterial thrombotic events.

Guidelines recommend the use of bridging heparin for patients with either inherited or acquired severe thrombophilia, defined as deficiency of anti-thrombin, protein C, or protein S, antiphospholipid antibody syndrome, homozygous factor V Leiden or prothrombin gene G20210A genotypes or combined heterozygous genotypes.

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