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A Call to Reduce the Use of Bridging Anticoagulation

Adam J Rose1, Arthur L Allen2, Tracy Minichello2

  • 1From the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, MA (A.J.R.); Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, MA (A.J.R.); Department of Pharmacy, VA Salt Lake City Healthcare System, UT (A.L.A.); Department of Medicine, San Francisco VA Medical Center, CA (T.M.); and Department of Medicine, University of California San Francisco School of Medicine (T.M.). adamrose@bu.edu.

Circulation. Cardiovascular Quality and Outcomes
|December 31, 2015
PubMed

Insights

Most patients on warfarin or direct-acting oral anticoagulants do not need bridging anticoagulation during surgery. Current guidelines are outdated, necessitating immediate practice changes to improve patient safety.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Recent studies have significantly altered understanding of perioperative anticoagulation management.
  • Existing consensus guidelines, including the 2012 American College of Chest Physicians Antithrombotic Guidelines, are now outdated.
  • Current practices may expose patients to unnecessary risks.

Purpose of the Study:

  • To highlight the need for updated guidelines on perioperative anticoagulation.
  • To inform clinicians about current evidence regarding bridging anticoagulation.
  • To address the safety concerns arising from outdated practices.

Main Methods:

  • Review of recent pivotal studies on anticoagulation management.
  • Analysis of current evidence for warfarin and direct-acting oral anticoagulants (DOACs).
  • Estimation of patient populations affected by current guidelines.

Main Results:

  • Over 90% of warfarin patients likely do not require bridging anticoagulation periprocedurally.
  • Evidence suggests bridging anticoagulation is also not indicated for patients on DOACs.
  • A significant number of patients are potentially affected by outdated practices.

Conclusions:

  • Immediate changes in clinical practice are required for perioperative anticoagulation.
  • Bridging anticoagulation should be reserved for rare, highly justified cases.
  • Updated guidelines are essential to ensure patient safety and optimize anticoagulation management.

Keywords:
anticoagulantsevidence-based medicineheparin, low-molecular weighthumansperioperative carepractice guidelinewarfarin

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