[Invasive procedures and long-term anti-coagulation: to bridge or not to bridge?]

Area of Science:

• Cardiology
• Hematology
• Pharmacology

Context:

• Long-term oral anticoagulation is crucial for managing thrombotic risks in conditions like venous thromboembolic disease (VTD), atrial fibrillation (AF), and mechanical heart valves.
• Approximately 10% of patients with these conditions require invasive procedures annually.
• Peri-procedural bridging anticoagulation aims to mitigate thrombotic events but presents a significant bleeding risk.

Purpose:

• To evaluate the current practices and risks associated with bridging anticoagulation in patients undergoing invasive procedures.
• To assess adherence to established guidelines for bridging anticoagulation therapy.

Summary:

• Bridging anticoagulation, using short half-life parenteral agents, is a common practice for patients needing invasive procedures while on long-term anticoagulation.
• Evidence indicates an increased risk of bleeding complications with bridging anticoagulation.
• Adherence to recommendations for bridging anticoagulation is low, with less than one-third of cases following guidelines.
• Bridging is recommended only for high thromboembolic risk scenarios, including recent VTD, AF with stroke history, or mechanical heart valves.

Impact:

• Highlights the potential for increased bleeding complications due to bridging anticoagulation, challenging its routine use.
• Underscores the need for improved adherence to clinical guidelines to optimize patient safety.
• Informs clinical decision-making regarding anticoagulation management peri-procedurally, particularly in high-risk patient populations.