[Bridging in patients with long-term oral anticoagulation - new recommendations]

Peri-interventional management of anticoagulation in patients receiving long-term anticoagulation can be challenging. The concept of "bridging" is known as an application of an anticoagulant with a short half-life (e. g. low-molecular-heparin) during interruption of therapy with vitamin-k-antagonists. Multiple studies have critically investigated the concept of bridging. Recently data from the ORBIT-AF-Register and the prospective randomized BRDIGE-Study have been released. The most common complication of bridging is bleeding. Overall the concept of bridging has lost some of its attractivity, especially concerning low or intermediate risk interventions or patients with a low risk of thromboembolism. An individual peri-interventional management based on individual patients' risk profile and interventional factors is recommended for VKA and NOACs. Main points of consideration are individual thromboembolic risk, specific bleeding risk of the planned intervention as well as patient factors (e. g. renal insufficiency).