To bridge or not to bridge: that is the question. The argument FOR bridging therapy in patients on oral anticoagulants requiring temporary interruption for elective procedures.

摘要

The perioperative management of patients on chronic oral anticoagulation with vitamin K antagonist (VKA) therapy is a common clinical problem. It is estimated that in North America alone approximately 1 in 10 patients receiving long-term warfarin, and are assessed for peri procedural management, for a total of 400,000-500,000 patients per year [1]. Although best clinical practices are not established, many of these patients will be assessed for peri-procedural bridging therapy. The goal of bridging therapy with parenteral heparin in therapeutic doses (either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH)) is to allow for continued anticoagulation during temporary discontinuation of VKA therapy for an elective procedure or surgery. Although patients with low thromboembolic risk may not necessarily benefit from bridging therapy, this article will discuss some of the arguments for periprocedural bridging therapy, especially in patients at moderate-to-high risk of thromboembolism.