Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trialNathan P. Clark, Pharm D, James D. Douketis, MD, Vic Hasselblad, PhD, Sam Schulman, MD, Andrei L. Kindzelski, MD, PhD, and Thomas L. Ortel, MD, PhD Aurora, CO; Ontario, Canada; Durham, NC; and Rockville, MD, for The BRIDGE Investigators

摘要

It is estimated that 10%-15% of patients taking warfarin require temporary interruption of the anticoagulant therapy for a surgery/procedure each year.13 Clinical practice guidelines recommend stopping warfarin 5 days prior to most surgeries/procedures to allow for normalization of the international normalized ratio (INR) and full restoration of clotting factor activity. Warfarin inactivates production of vitamin K-dependent clotting factors indirectly through inhibition of vitamin K epoxide reductase.5 As a result, there is a delay in reestablishing a therapeutic anticoagulant effect of 5-7 days after warfarin is restarted,5 and a longer period may be required in the postprocedure setting.6'7 Patients with atrial fibrillation may be susceptible to potentially avoidable thromboembolic complications during this period of warfarin withdrawal and reinitiation around a surgery or invasive procedure which led to the practice of bridge therapy with low-molecular weight heparin* (LMWH) in an attempt to mitigate this risk.8