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Bridging therapy and oral anticoagulation: current and future prospects
1McMaster University, Department of Medicine, Hamilton General Hospital Thrombosis Unit, Hamilton, Ontario, Canada. spyropa@mcmaster.ca
Current Opinion in Hematology
|July 9, 2010
Summary
Patients on vitamin K antagonist (VKA) therapy need careful management during procedures. Bridging therapy with heparin may be necessary for high thromboembolic risk, balancing bleeding and clotting risks.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Management
Background:
- Patients on vitamin K antagonist (VKA) therapy face elevated bleeding risks during invasive procedures.
- Bridging therapy with heparin aims to prevent thromboembolism during temporary VKA interruption.
- Decision-making for VKA interruption and bridging involves assessing patient and procedural risks.
Purpose of the Study:
- To review current practices and recent findings in periprocedural anticoagulation management.
- To evaluate the role and safety of bridging therapy in patients undergoing procedures.
- To discuss emerging alternatives to VKA therapy.
Main Methods:
- Review of recent clinical findings and ongoing placebo-controlled trials.
- Analysis of risk stratification for thromboembolism and bleeding.
- Evaluation of different heparin formulations for bridging therapy.
Main Results:
- Minor procedures may not require VKA interruption.
- Bridging therapy is beneficial for patients at moderate-to-high thromboembolic risk.
- Low-molecular-weight heparin is preferred over unfractionated heparin for bridging, especially in outpatient settings.
Conclusions:
- Procedural bleeding risk dictates the resumption of bridging and VKA therapies.
- Ongoing trials are investigating the efficacy and safety of bridging strategies.
- Future anticoagulation management may involve alternatives to VKA therapy.
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