Bridging anticoagulation

Associated trial of patients with atrial fibrillation who stopped taking warfarin before elective surgery or an invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin to prevent arterial thromboembolism(Douketis JD et al).

In the above study bridging nearly tripled the risk of major bleeding without providing benefits in preventing myocardial infarction, venous thromboembolism, or death when compared with no bridging.

The above study suggests that the risk of arterial thromboembolism in patients with atrial fibrillation who temporarily stop warfarin may have been over stated.

In the above BRIDGE study- Bridging Anticoagulation in Patients Who Require Temporary Interruption of Warfarin Therapy for an Elective Invasive Procedure or Surgical clinical trial2000 patients randomly signed to bridging protocol with low molecular weight heparin or foregoing anticoagulation bridging when undergoing a procedur6e- A strategy of foregoing in the anticoagulation bridging was non inferior to bridging with low molecular weight heparin in terms of preventing arterial thrombotic events and there was improvement in both major and blood minor bleeding events.

Periprocedural anticoagulation management results in very low periprocedural events irrespective of thrombophilia status.

In a review of 28 cohort studies periprocedural bridging increased the risk of bleeding compared with VKA int2242uption without bridging, without a significant difference in periprocedural venous thromboembolism rates (Baumgartmer C).

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