The current status of bridging anticoagulation

Area of Science:

• Cardiology
• Pharmacology
• Surgical Management

Background:

• Patients on chronic vitamin K antagonist therapy often require surgical or invasive procedures.
• Decisions regarding bridging anticoagulation are common but evidence-based guidelines are lacking.
• The introduction of novel oral anticoagulants (NOACs) presents new challenges in peri-procedural management.

Purpose of the Study:

• To review the current clinical practice and evidence base for bridging anticoagulation in patients undergoing procedures.
• To highlight the deficiencies in current evidence, particularly concerning NOACs.
• To emphasize the need for prospective studies to guide peri-procedural management.

Main Methods:

• Review of existing literature and clinical practice guidelines.
• Analysis of the evolving landscape of anticoagulation therapies.
• Identification of research gaps in peri-procedural management.

Main Results:

• Current practices for bridging anticoagulation are not consistently supported by robust evidence.
• Significant gaps exist in understanding the optimal peri-procedural management of novel oral anticoagulants.
• Ongoing clinical trials with conventional anticoagulants may provide some future evidence.

Conclusions:

• Further high-quality, prospective, multi-center controlled studies are essential.
• Evidence is critically needed to establish best practices for peri-procedural management of both conventional and novel oral anticoagulants.
• Improved evidence will enhance patient safety and optimize anticoagulation management during invasive procedures.