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Bridging Anticoagulation: Primum Non Nocere.

Stephen J Rechenmacher1, James C Fang1

  • 1Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.

Journal of the American College of Cardiology
|September 19, 2015
PubMed
Summary

Bridging anticoagulation during interruptions of chronic oral anticoagulation may increase bleeding without reducing thromboembolism. Physicians should carefully weigh the need for bridging versus risks, awaiting further trial evidence.

Keywords:
bleedingbridgingperioperativeperiproceduralthromboembolism

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Chronic oral anticoagulation necessitates periodic interruption for medical procedures.
  • Decisions regarding bridging anticoagulation with agents like heparin are complex due to limited evidence.
  • Current guidelines for bridging therapy are often equivocal and lack precision.

Purpose of the Study:

  • To evaluate the current clinical dilemma surrounding bridging anticoagulation during interruptions of chronic oral anticoagulation.
  • To analyze recent evidence regarding the efficacy and safety of bridging strategies.
  • To inform clinical decision-making and guide future research in anticoagulation management.

Main Methods:

  • Review of new observational studies and a recent large randomized trial on bridging anticoagulation.
  • Analysis of perioperative and periprocedural bleeding rates associated with bridging.
  • Assessment of thromboembolic event rates in patients receiving bridging therapy.

Main Results:

  • Recent studies indicate significant rates of perioperative/periprocedural bleeding when bridging anticoagulation is employed.
  • Bridging therapy has not demonstrated a reduction in thromboembolic events.
  • Bleeding complications associated with bridging can lead to increased morbidity and mortality.

Conclusions:

  • Physician practices of routine bridging anticoagulation may be overly aggressive.
  • Further randomized trials, such as PERIOP2, are needed to guide periprocedural anticoagulation management.
  • Clinicians must carefully consider the necessity of anticoagulation interruption and the risks/benefits of bridging therapy.